Provider Demographics
NPI:1215619945
Name:ARIC PETERSEN PLLC
Entity type:Organization
Organization Name:ARIC PETERSEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-780-7802
Mailing Address - Street 1:10752 N 89TH PL STE 117
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6743
Mailing Address - Country:US
Mailing Address - Phone:314-780-7802
Mailing Address - Fax:480-767-8818
Practice Address - Street 1:10752 N 89TH PL STE 117
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6743
Practice Address - Country:US
Practice Address - Phone:314-780-7802
Practice Address - Fax:480-767-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty