Individual
LORIN DEAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086373
—
AZ
Enumeration date
06/30/2005
Last updated
07/17/2007
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