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Individual
GILMAN PETERSON III
Active
Individual
GILMAN PETERSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD MD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7976
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7976
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
7976
KY
Other
Enumeration date
07/09/2008
Last updated
03/09/2011
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