Provider Demographics
NPI:1568467975
Name:PETERSON, CHRISTI ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTI
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3772 KATELLA AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6429
Mailing Address - Country:US
Mailing Address - Phone:562-493-6106
Mailing Address - Fax:562-493-6235
Practice Address - Street 1:3772 KATELLA AVE
Practice Address - Street 2:STE 207
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6429
Practice Address - Country:US
Practice Address - Phone:562-493-6106
Practice Address - Fax:562-493-6235
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice