Individual
STEPHAN L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
240 LOCUST ST, DOVER, NH 03820
(603) 742-6546
(603) 742-7043
Mailing address
240 LOCUST ST, DOVER, NH 03820
(603) 742-6546
(603) 742-7043
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1725
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202034Y0NH01
FED BC BS
—
01
—
139950000
MAINE CARE
ME
05
—
89192034
—
NH
Enumeration date
12/08/2006
Last updated
05/16/2016
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