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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