Provider Demographics
NPI:1417960782
Name:PETERSEN AND WELLER DDS PLLC
Entity Type:Organization
Organization Name:PETERSEN AND WELLER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-485-6540
Mailing Address - Street 1:22833 BOTHELL EVERETT HWY SE
Mailing Address - Street 2:STE #205
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021
Mailing Address - Country:US
Mailing Address - Phone:425-485-6540
Mailing Address - Fax:425-486-1740
Practice Address - Street 1:22833 BOTHELL EVERETT HWY SE
Practice Address - Street 2:STE #205
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021
Practice Address - Country:US
Practice Address - Phone:425-485-6540
Practice Address - Fax:425-486-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA54711223G0001X
WA84851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty