Provider Demographics
NPI:1841308947
Name:SCOTT S PETERS DDS PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SCOTT S PETERS DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-226-5000
Mailing Address - Street 1:3796 N FRESNO ST STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-5500
Mailing Address - Country:US
Mailing Address - Phone:559-226-5000
Mailing Address - Fax:559-227-4457
Practice Address - Street 1:1925 W VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6020
Practice Address - Country:US
Practice Address - Phone:559-226-5000
Practice Address - Fax:559-227-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223S0112X
CA333531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty