Individual
MARCUS E PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
402 6TH ST, RUPERT, ID 83350-1619
(208) 650-7941
(208) 436-0735
Mailing address
794 EASTLAND DR, TWIN FALLS, ID 83301-6856
(208) 737-6718
(208) 734-5036
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8782
OR
Other
Enumeration date
09/07/2006
Last updated
04/13/2021
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