Eric A Pettersen, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

033829 Issued in CA

Practice address

25460 Medical Center Dr
#200
Murrieta, CA 92562-5985

Phone

(951) 677-7322

Fax

(951) 677-1860

NPI assigned

Jan 30, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174660492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25460 MEDICAL CENTER DR",
            "address_2": "#200",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925625985",
            "telephone_number": "951-677-7322",
            "fax_number": "951-677-1860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25460 MEDICAL CENTER DR",
            "address_2": "#200",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925625985",
            "telephone_number": "951-677-7322",
            "fax_number": "951-677-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSEN",
        "first_name": "ERIC",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "033829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trenton Lee Peterson, PA-C
• Robyn Petri
• Stephanie Petrick
• Candide J. Petrol, D.D.S.
• Washington Petrus
• Karlton Petty Jr
• Dao Kim Pham-Nguyen, DDS
• Binh Gia Pham, PHARM.D
• Christine Pham, DDS
• Leslie Nhi Pham, O.D.

• Endodontics in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Endodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.