Individual
CHRISTIAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(406) 750-7640
Mailing address
2743 W PEAK CLOUD LN APT 410, MERIDIAN, ID 83642-8862
(406) 750-7640
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3061575
ID
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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