Provider Demographics
NPI:1073690889
Name:AMUNDSON, PETER BRENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRENT
Last Name:AMUNDSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 S UNIVERSITY BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:303-773-9400
Mailing Address - Fax:303-773-9518
Practice Address - Street 1:7900 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-5102
Practice Address - Country:US
Practice Address - Phone:303-773-9400
Practice Address - Fax:303-773-9518
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0074851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice