Organization
MARK E PETERSON, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PETERSON DDS (DENTIST)
(616) 784-8444
Entity
Organization
Contact information
Practice address
2440 GAYNOR AVE NW, GRAND RAPIDS, MI 49544-1830
(616) 784-8444
(616) 784-6912
Mailing address
2440 GAYNOR AVE NW, GRAND RAPIDS, MI 49544-1830
(616) 784-8444
(616) 784-6912
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/13/2019
Last updated
03/14/2019
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