Basic Information
| Provider Information | |||||||||
| NPI: | 1396978458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | WARREN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 HIGROVE PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LEEDS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350941700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056991155 | ||||||||
| FaxNumber: | 2056991159 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 HIGROVE PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LEEDS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350941700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056991155 | ||||||||
| FaxNumber: | 2056991159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2009 | ||||||||
| LastUpdateDate: | 01/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 5696 | AL | Y | Dental Providers | Dentist |
No ID Information.