| NPI | 1467611624 |
|---|---|
| Doing Business As | PETERSON DENTAL |
| Entity Type | Organization |
| Authorized Contact | MARK L PETERSON Dentist 208-745-6536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1758) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-06-03 |