Individual
TONY LEROY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1050 S 8TH ST, COLORADO SPRINGS, CO 80905-7307
(719) 633-8455
Mailing address
1050 S 8TH ST, COLORADO SPRINGS, CO 80905-7307
(719) 633-8455
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10364
CO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
1236
WY
Other
Enumeration date
10/31/2005
Last updated
01/29/2014
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