Provider Demographics
NPI:1356678650
Name:PETERSON, HANNAH B (RDH)
Entity Type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:B
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 E LEIGH DR
Mailing Address - Street 2:#3
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8162
Mailing Address - Country:US
Mailing Address - Phone:610-909-7235
Mailing Address - Fax:610-909-7235
Practice Address - Street 1:3140 CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7131
Practice Address - Country:US
Practice Address - Phone:928-445-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6659124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ179557OtherACCCHS PROVIDER