Individual
DR. BRIAN R. PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6812 E BROWN RD, SUITE 101, MESA, AZ 85207-3757
(480) 325-3368
(480) 325-0718
Mailing address
6812 E BROWN RD, SUITE 101, MESA, AZ 85207-3757
(480) 325-3368
(480) 325-0718
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D 5014
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
477754
ACCESS ID
AZ
Enumeration date
08/31/2006
Last updated
07/08/2007
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