Individual
DR. MELANIE R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1001 W. 10TH STREET, #3101, INDIANAPOLIS, IN 46202-2859
(317) 278-3632
(317) 274-2603
Mailing address
1121 W. MICHIGAN STREET, DS 307B, INDIANAPOLIS, IN 46202-5186
(317) 278-3632
(317) 274-2603
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
5104
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12011735A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007279
DORAL
KY
05
—
100001450A
—
IN
05
—
60051042
—
KY
Enumeration date
09/12/2006
Last updated
06/19/2012
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