Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D009036 | AZ |
NPI | 1003221219 |
---|---|
Provider Name | Dr. Allison Spera Pederson |
First Address | Scottsdale, AZ 85255-6030 |
Second Address | Scottsdale, AZ 85251-7620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 20/01/2021 |