# PETERSON, KRISCHE, VAN HORN, DDS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417945544
- **Authorized official:** DR. KENT T PETERSON DDS (MANAGING PARTNER)
- **Authorized official phone:** (785) 842-0705

## Contact information

- **Practice address:** 2210 YALE RD, LAWRENCE, KS 66049-2647
- **Practice address phone:** (785) 842-0705
- **Practice address fax:** (785) 865-2324
- **Mailing address:** 2210 YALE RD, LAWRENCE, KS 66049-2647
- **Mailing address phone:** (785) 842-0705
- **Mailing address fax:** (785) 865-2324

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2005
- **Last updated:** 08/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 420744 | BLUE CROSS BLUE SHIELD | KS |