Individual
KENT T PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2210 YALE RD, LAWRENCE, KS 66049-2647
(785) 842-0705
(785) 865-2324
Mailing address
2210 YALE RD, LAWRENCE, KS 66049-2647
(785) 842-0705
(785) 865-2324
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6852
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116690
BCBS
KS
Enumeration date
03/17/2006
Last updated
07/08/2007
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