Lorin Dean Peterson, DMD

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

2803 Issued in AZ

Practice address

77 W Forest Ave
Ste 107
Flagstaff, AZ 86001-1482

Phone

(928) 773-2530

Fax

(928) 773-2532

NPI assigned

Jun 30, 2005

Last updated

Jul 17, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oral and Maxillofacial Surgeons of Northern Arizona

  • Oral and Maxillofacial Pathology Dentistry
  • Flagstaff, AZ
  • NPI 1487651071
  Authorized official Same address or phone

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184630400000",
    "number": "1699772061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W FOREST AVE",
            "address_2": "STE 107",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011482",
            "telephone_number": "928-773-2530",
            "fax_number": "928-773-2532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W FOREST AVE",
            "address_2": "STE 107",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011482",
            "telephone_number": "928-773-2530",
            "fax_number": "928-773-2532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LORIN",
        "middle_name": "DEAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2007-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "AZ",
            "license": "2803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086373",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ammon Christian Peterson, PT, DPT
• Eric Peterson, DDS MSD
• Jennifer C Peterson, M.D.
• Kathryn Louise Peterson, LCSW
• Lindsey Peterson, NCSP
• Mark Peterson, D.O.
• Royce T Peterson, D.M.D.
• Brittany Petrick, L.AC, MSOM
• Dawn L Pfeffer, PT
• Quan Minh Pham, PHARM.D.

• Oral and Maxillofacial Pathology Dentistry in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Oral and Maxillofacial Pathology Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.