Individual
DR. WAYNE MICHAEL PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1138 W A ST, MOSCOW, ID 83843-2127
(208) 882-9310
(208) 882-8601
Mailing address
1138 W A ST, MOSCOW, ID 83843-2127
(208) 882-9310
(208) 882-8601
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1686
ID
Other
Enumeration date
06/07/2006
Last updated
07/08/2007
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