Provider Demographics
NPI:1699048439
Name:SHON J PETERSON, DMD, MS
Entity type:Organization
Organization Name:SHON J PETERSON, DMD, MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-452-4656
Mailing Address - Street 1:11265 DECATUR ST STE 400
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4793
Mailing Address - Country:US
Mailing Address - Phone:303-452-4656
Mailing Address - Fax:303-254-6994
Practice Address - Street 1:11265 DECATUR ST STE 400
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-4793
Practice Address - Country:US
Practice Address - Phone:303-452-4656
Practice Address - Fax:303-254-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty