Provider Demographics
NPI:1912007113
Name:ANDREW A. PETERSON DDS LTD
Entity Type:Organization
Organization Name:ANDREW A. PETERSON DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-422-7640
Mailing Address - Street 1:300 W WALLACE ST
Mailing Address - Street 2:SUITE A3
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1242
Mailing Address - Country:US
Mailing Address - Phone:419-422-7640
Mailing Address - Fax:419-422-3025
Practice Address - Street 1:300 W WALLACE ST
Practice Address - Street 2:SUITE A3
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1242
Practice Address - Country:US
Practice Address - Phone:419-422-7640
Practice Address - Fax:419-422-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0221921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty