Provider Demographics
NPI:1578028379
Name:PETERS DENTAL CORPORATION
Entity Type:Organization
Organization Name:PETERS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-478-8463
Mailing Address - Street 1:600 CORPORATE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2112
Mailing Address - Country:US
Mailing Address - Phone:949-799-4644
Mailing Address - Fax:949-545-7441
Practice Address - Street 1:600 CORPORATE DR STE 260
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2112
Practice Address - Country:US
Practice Address - Phone:949-799-4644
Practice Address - Fax:949-545-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental