# PETERSON AND CAMMACK, D.D.S., P.L.L.C

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

## Provider details

- **NPI number:** 1437494036
- **Authorized official:** DR. VENN ROGER PETERSON D.D.S. (PRESIDENT)
- **Authorized official phone:** (360) 459-4420

## Contact information

- **Practice address:** 5201 CORPORATE CENTER CT SE, LACEY, WA 98503-5901
- **Practice address phone:** (360) 459-4420
- **Practice address fax:** (360) 459-4425
- **Mailing address:** 5201 CORPORATE CENTER CT SE, LACEY, WA 98503-5901
- **Mailing address phone:** (360) 459-4420
- **Mailing address fax:** (360) 459-4425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00008985 | WA | Yes |

## Other

- **Enumeration date:** 12/07/2012
- **Last updated:** 12/07/2012