Individual
DR. JUSTIN THOMAS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
325 E MAIN ST, SAINT ANTHONY, ID 83445-1546
(208) 356-4900
(208) 624-4117
Mailing address
PO BOX 18, SAINT ANTHONY, ID 83445-0018
(208) 356-4900
(208) 624-4117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4293
ID
Other
Enumeration date
06/28/2010
Last updated
05/17/2022
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