Individual
KATIE DAWN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
920 N MAIN ST, MOUNTAIN GROVE, MO 65711-1315
(417) 926-4910
(417) 926-4399
Mailing address
920 N MAIN ST, MOUNTAIN GROVE, MO 65711-1315
(417) 926-4910
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2012015429
MO
Other
Enumeration date
06/13/2012
Last updated
06/13/2012
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