MEDICARE: DR. CHRISTOPHER LAWRENCE PETTERSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN7570	FL

General Provider Information

NPI Number	:	1932397536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER LAWRENCE PETTERSON D.D.S.

Provider Business Mailing Address
First Line	:	140 BEACH SUMMIT CT
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33477-9629
Country	:	US
Telephone Number	:	561-743-5230
Fax Number	:	561-743-5230

Provider Business Practice Location Address
First Line	:	10157 S FEDERAL HWY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5609
Country	:	US
Telephone Number	:	772-337-1127
Fax Number	:	772-337-1121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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