Individual
STACY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1927 COLORADO STATE HWY 7, SUITE 101, ERIE, CO 80516
(720) 874-9039
Mailing address
11605 DESTINATION DR APT 5404, BROOMFIELD, CO 80021-4793
(701) 426-9415
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN.00205330
CO
Other
Enumeration date
06/07/2022
Last updated
08/31/2022
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