Individual
DR. GARY RAY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3815 STEPHENS AVE, MISSOULA, MT 59801-8505
(406) 728-0200
Mailing address
3815 STEPHENS AVE, MISSOULA, MT 59801-8505
(406) 728-0201
(406) 728-0201
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1359
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120037
—
MT
Enumeration date
12/27/2006
Last updated
04/13/2016
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