| NPI | 1164569489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON CHARLES PETERSON Owner 319-364-5561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 6573) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-08-22 |