Individual
DR. WAYNE R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2427 N COLE RD, BOISE, ID 83704-5907
(208) 322-8877
Mailing address
3200 S WADSWORTH BLVD UNIT E, LAKEWOOD, CO 80227-5010
(303) 716-8546
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3654
ID
Other
Enumeration date
11/01/2006
Last updated
02/04/2015
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