Provider Demographics
NPI:1063637197
Name:ROLLINS & PETERSEN ORTHODONTICS PLC
Entity type:Organization
Organization Name:ROLLINS & PETERSEN ORTHODONTICS PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARLON
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-924-2880
Mailing Address - Street 1:6755 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:480-924-2880
Mailing Address - Fax:480-924-5634
Practice Address - Street 1:6755 E SUPERSTITION SPRINGS BLVD
Practice Address - Street 2:STE 201
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-924-2880
Practice Address - Fax:480-924-5634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47931223X0400X
AZ19611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty