Individual
DR. THOMAS RUDOLPH PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1501 PLOVER ST, STEVENS POINT, WI 54481
(715) 344-2324
Mailing address
1501 PLOVER ST, STEVENS POINT, WI 54481
(715) 344-2324
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WI1187G
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33564600
—
WI
Enumeration date
11/21/2006
Last updated
07/08/2007
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