Organization
WAYNE PETERSON DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE MICHAEL PETERSON DMD (PRESIDENT)
(208) 882-9310
Entity
Organization
Contact information
Practice address
1138 WEST A ST, MOSCOW, ID 83843
(208) 882-9310
(208) 882-8601
Mailing address
1138 WEST A ST, MOSCOW, ID 83843
(208) 882-9310
(208) 882-8601
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1686
ID
Other
Enumeration date
06/12/2008
Last updated
06/12/2008
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