Individual
DR. SCOTT MATHEW PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
111 N REGENCY DR, BLOOMINGTON, IL 61701-3515
(309) 662-5331
(309) 663-1112
Mailing address
111 N REGENCY DR, BLOOMINGTON, IL 61701-3515
(309) 662-5331
(309) 663-1112
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021-002109
IL
Other
Enumeration date
05/15/2008
Last updated
05/15/2008
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