Individual
DR. JOHN GREGORY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
9201 W OVERLAND RD, BOISE, ID 83709-2502
(208) 375-0185
(208) 375-0305
Mailing address
9201 W OVERLAND RD, BOISE, ID 83709-2502
(208) 375-0185
(208) 375-0305
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-3921
ID
Other
Enumeration date
02/08/2007
Last updated
07/08/2007
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