Organization
FAIRFIELD DENTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM MARC PETERSEN D.D.S. (PRESIDENT)
(509) 283-2261
Entity
Organization
Contact information
Practice address
214 E MAIN, FAIRFIELD, WA 99012
(509) 283-2261
(509) 283-2261
Mailing address
PO BOX 305, FAIRFIELD, WA 99012-0305
(509) 283-2261
(509) 283-2261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/23/2007
Last updated
06/23/2008
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