Organization
GERALD D. PETERSEN, D.D.S., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD D. PETERSEN D.D.S. (OFFICER)
(262) 548-3555
Entity
Organization
Contact information
Practice address
S22 W22660 EAST BROADWAY, STE 2B, WAUKESHA, WI 53186
(262) 548-3555
(262) 965-2826
Mailing address
S22 W22660 EAST BROADWAY, STE 2B, WAUKESHA, WI 53186
(262) 548-3555
(262) 965-2826
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/05/2006
Last updated
08/22/2020
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