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1225255748
JASON M PETERSON
IDAHO FALLS, ID
NPI
1225255748
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223P0300X Dentist Periodontics
(Licence: ID D3325PE)
Enumeration Date
2007-04-18
Last Update Date
2007-07-08
Business Address
JASON M PETERSON DDS
1980 1ST ST
IDAHO FALLS, ID 83401-4342
Phone number: 208-524-3400
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Mailing Address
JASON M PETERSON DDS
1980 1ST ST
IDAHO FALLS, ID 83401-4342
Phone number: 208-524-3400
Copy
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