# PETERSON DENTISTRY DDS INC

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

## Provider details

- **NPI number:** 1639661341
- **Authorized official:** GREGORY PETERSON DDS (OWNER)
- **Authorized official phone:** (714) 672-9000

## Contact information

- **Practice address:** 503 E IMPERIAL HWY, BREA, CA 92821-5544
- **Practice address phone:** (714) 672-9000
- **Practice address fax:** (714) 672-9086
- **Mailing address:** 503 E IMPERIAL HWY, BREA, CA 92821-5544
- **Mailing address phone:** (714) 672-9000
- **Mailing address fax:** (714) 672-9086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 57102 | CA | Yes |

## Other

- **Enumeration date:** 05/30/2018
- **Last updated:** 05/30/2018