Individual
DR. DEREK GENE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3303 W 144TH AVE UNIT 100, BROOMFIELD, CO 80023-9464
(720) 308-9798
Mailing address
3303 W 144TH AVE UNIT 100, BROOMFIELD, CO 80023-9464
(720) 308-9798
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9978
CO
Other
Enumeration date
08/25/2009
Last updated
02/05/2014
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