Lorin D. Peterson, D.D.S.
Individual provider Active NPI General Practice Dentistry · Cle Elum, WA
NPI 1932321858 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1932321858
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DE00005472 (WA)
- Practice address
- 101 Harris Ave
Cle Elum, WA 98922-0580 - Phone
- (509) 674-5153
- Fax
- (509) 674-7354
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00005472 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lorin Peterson DDS | Past | Accepting new patients | |
| Wesley Johnson ,DDS,Inc.,PS | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00005472 | WA | Yes |
Addresses
Primary practice location
101 Harris Ave
Cle Elum, WA 98922-0580
Mailing address
101 Harris Ave
P.O. Box 580
Cle Elum, WA 98922-0580
Phone (509) 674-5153
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5775002 | Medicaid | WA |
Other providers in Cle Elum, WA
- Chelsea Newman
- Leah Rachelle Norrbom
- Brian Oppen
- Margaret Pace
- Peaks Sports & Spine Physical Therapy
- Craig S Pigeon
- Rebecca Lee Proulx
- Patricia Frances Radzykewycz
- Bonnie Sue Reay
- Denise Mehlenbacher Robinson
All providers in Cle Elum, WA · General Practice Dentistry in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.