# ANDREW M PETERSEN, DDS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114189883
- **Authorized official:** DR. ANDREW MARVIN PETERSEN DDS (OWNER)
- **Authorized official phone:** (480) 893-7733

## Contact information

- **Practice address:** 4802 E RAY RD, SUITE \#19, PHOENIX, AZ 85044-6405
- **Practice address phone:** (480) 893-7733
- **Mailing address:** 4802 E RAY RD, SUITE \#19, PHOENIX, AZ 85044-6405
- **Mailing address phone:** (480) 893-7733

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7013 | AZ | Yes |

## Other

- **Enumeration date:** 06/25/2008
- **Last updated:** 06/25/2008