Organization
PETERSON, KRISCHE, VAN HORN, DDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENT T PETERSON DDS (MANAGING PARTNER)
(785) 842-0705
Entity
Organization
Contact information
Practice address
2210 YALE RD, LAWRENCE, KS 66049-2647
(785) 842-0705
(785) 865-2324
Mailing address
2210 YALE RD, LAWRENCE, KS 66049-2647
(785) 842-0705
(785) 865-2324
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
420744
BLUE CROSS BLUE SHIELD
KS
Enumeration date
10/12/2005
Last updated
08/01/2011
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