TY PETERSON

GOODING, ID
NPI1689234437
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: ID  D-5035)
Enumeration Date2019-06-14
Last Update Date2019-06-14
Business Address
TY PETERSON DMD
325 MAIN ST
GOODING, ID 83330-1302
Phone number: 208-934-8080
Mailing Address
TY PETERSON DMD
325 MAIN ST
GOODING, ID 83330-1302
Phone number: