NPI | 1639595952 |
---|---|
Entity Type | Organization |
Authorized Contact | DONALD CRAIG PETERSON Doctor/Owner 319-351-5439 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 08193) |
Enumeration Date | 2014-03-11 |
Last Update Date | 2014-03-11 |