Provider Demographics
NPI:1053585679
Name:DAVID PETERSON, INC.
Entity type:Organization
Organization Name:DAVID PETERSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:1661-834-4111
Mailing Address - Street 1:4124 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4982
Mailing Address - Country:US
Mailing Address - Phone:661-834-4111
Mailing Address - Fax:661-834-0927
Practice Address - Street 1:4124 ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4982
Practice Address - Country:US
Practice Address - Phone:661-834-4111
Practice Address - Fax:661-834-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty