Individual
DR. AUSTIN M PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3935 E SOUTHPORT RD, INDIANAPOLIS, IN 46237-3203
(317) 244-3000
Mailing address
1616 ROLLING HILLS DR, CRYSTAL LAKE, IL 60014-2969
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1001921-15
WI
122300000X
Dentist
Primary
12013338A
IN
Other
Enumeration date
08/23/2018
Last updated
08/19/2020
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