Provider Demographics
NPI:1942390927
Name:PETERSON, JAMES SWANBERG (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SWANBERG
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 S DENTON TAP RD
Mailing Address - Street 2:#103
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:598 S DENTON TAP RD
Practice Address - Street 2:#103
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4004
Practice Address - Country:US
Practice Address - Phone:972-462-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice