Individual
CRAIG A. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
6226 14TH AVE, KENOSHA, WI 53143-4413
(262) 656-0044
Mailing address
1400 COLLEGE AVE, RACINE, WI 53403-1991
(309) 236-5891
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6941-15
WI
Other
Enumeration date
06/25/2012
Last updated
06/25/2012
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