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1689234437
TY PETERSON
GOODING, ID
NPI
1689234437
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: ID D-5035)
Enumeration Date
2019-06-14
Last Update Date
2019-06-14
Business Address
TY PETERSON DMD
325 MAIN ST
GOODING, ID 83330-1302
Phone number: 208-934-8080
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Mailing Address
TY PETERSON DMD
325 MAIN ST
GOODING, ID 83330-1302
Phone number:
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