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Organization
ORAL AND MAXILLOFACIAL SURGEONS OF NORTHERN ARIZONA
Active
Organization
ORAL AND MAXILLOFACIAL SURGEONS OF NORTHERN ARIZONA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORIN DEAN PETERSON DMD (PRESIDENT)
(928) 773-2530
Entity
Organization
Contact information
Practice address
77 W FOREST AVE, STE 107, FLAGSTAFF, AZ 86001-1482
(928) 773-2530
(928) 773-2532
Mailing address
77 W FOREST AVE, STE 107, FLAGSTAFF, AZ 86001-1482
(928) 773-2530
(928) 773-2532
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
2803
AZ
Other
Enumeration date
06/28/2005
Last updated
10/16/2007
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