Individual
KEVIN MICHAEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1607 WESTGATE CIR STE 400, BRENTWOOD, TN 37027-8080
(615) 829-7150
Mailing address
11901 ABESS BLVD APT 4123, JACKSONVILLE, FL 32225-6041
(906) 281-1915
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11169
TN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
23982
FL
Other
Enumeration date
10/28/2019
Last updated
11/05/2019
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