Individual
DR. JOSHUA PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1687 TABLEROCK RD, RAPID CITY, SD 57701-5495
(605) 342-6652
Mailing address
1687 TABLEROCK RD, RAPID CITY, SD 57701-5495
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1231
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D1231
LICENSE
SD
Enumeration date
06/03/2019
Last updated
06/03/2019
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