Organization
PETERSON FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN G PETERSON DMD (DENTIST)
(208) 375-0185
Entity
Organization
Contact information
Practice address
9201 W OVERLAND RD, BOISE, ID 83709-2502
(208) 375-0185
(208) 375-0305
Mailing address
9201 W OVERLAND RD, BOISE, ID 83709-2502
(208) 375-0185
(208) 375-0305
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3921
ID
Other
Enumeration date
06/02/2008
Last updated
06/02/2008
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