Individual
DR. DOREEN MARIE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
131 RIDGE RD, SUITE 2 NORTH, MUNSTER, IN 46321-1566
(219) 836-8886
(219) 836-8846
Mailing address
131 RIDGE RD, SUITE 2 NORTH, MUNSTER, IN 46321-1566
(219) 836-8886
(219) 836-8846
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008952
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100424320
—
IN
Enumeration date
09/04/2006
Last updated
07/08/2007
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