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Organization

KATIE D. PETERSON, DDS, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KATIE DAWN PETERSON DDS (PRESIDENT)
(417) 926-4910
Entity
Organization

Contact information

Practice address
920 N MAIN ST, MOUNTAIN GROVE, MO 65711-1315
(417) 926-4910
(417) 926-4399
Mailing address
920 N MAIN ST, MOUNTAIN GROVE, MO 65711-1315
(417) 926-4910
(417) 926-4399

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2012015429
MO

Other

Enumeration date
06/25/2012
Last updated
06/25/2012
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