Individual
GERALD D PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
S22 W22660 EAST BROADWAY #2B, WAUKESHA, WI 53186
(262) 548-3555
Mailing address
S41W34610 BIG OAK DR, DOUSMAN, WI 53118-9721
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3340
WI
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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