Individual
GEOFF PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3751 SW HOLLYWOOD DR, LEES SUMMIT, MO 64082-7830
(816) 623-3563
Mailing address
3751 SW HOLLYWOOD DR, LEES SUMMIT, MO 64082-7830
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2013025331
MO
Other
Enumeration date
07/18/2013
Last updated
07/18/2013
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