Individual
DR. MICHELLE LYNN PETERSEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
8010 STATE LINE RD, SUITE 210, PRAIRIE VILLAGE, KS 66208-3710
(913) 341-2200
(913) 648-7605
Mailing address
8010 STATE LINE RD, SUITE 210, PRAIRIE VILLAGE, KS 66208-3710
(913) 341-2200
(913) 648-7605
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5735
KS
Other
Enumeration date
02/28/2006
Last updated
07/08/2007
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