# MARK E PETERSON, DDS

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

## Provider details

- **NPI number:** 1639638265
- **Authorized official:** MARK PETERSON DDS (DENTIST)
- **Authorized official phone:** (616) 784-8444

## Contact information

- **Practice address:** 2440 GAYNOR AVE NW, GRAND RAPIDS, MI 49544-1830
- **Practice address phone:** (616) 784-8444
- **Practice address fax:** (616) 784-6912
- **Mailing address:** 2440 GAYNOR AVE NW, GRAND RAPIDS, MI 49544-1830
- **Mailing address phone:** (616) 784-8444
- **Mailing address fax:** (616) 784-6912

## Taxonomy

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

## Other

- **Enumeration date:** 03/13/2019
- **Last updated:** 03/14/2019