# ORAL AND MAXILLOFACIAL SURGEONS OF NORTHERN ARIZONA

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

## Provider details

- **NPI number:** 1487651071
- **Authorized official:** LORIN DEAN PETERSON DMD (PRESIDENT)
- **Authorized official phone:** (928) 773-2530

## Contact information

- **Practice address:** 77 W FOREST AVE, STE 107, FLAGSTAFF, AZ 86001-1482
- **Practice address phone:** (928) 773-2530
- **Practice address fax:** (928) 773-2532
- **Mailing address:** 77 W FOREST AVE, STE 107, FLAGSTAFF, AZ 86001-1482
- **Mailing address phone:** (928) 773-2530
- **Mailing address fax:** (928) 773-2532

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 2803 | AZ | Yes |

## Other

- **Enumeration date:** 06/28/2005
- **Last updated:** 10/16/2007