# FAIRFIELD DENTAL CLINIC, LLC

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

## Provider details

- **NPI number:** 1598975849
- **Authorized official:** DR. WILLIAM MARC PETERSEN D.D.S. (PRESIDENT)
- **Authorized official phone:** (509) 283-2261

## Contact information

- **Practice address:** 214 E MAIN, FAIRFIELD, WA 99012
- **Practice address phone:** (509) 283-2261
- **Practice address fax:** (509) 283-2261
- **Mailing address:** PO BOX 305, FAIRFIELD, WA 99012-0305
- **Mailing address phone:** (509) 283-2261
- **Mailing address fax:** (509) 283-2261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 06/23/2008