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Individual

VENN R PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
5024 LACEY BLVD SE, LACEY, WA 98503-5729
(360) 459-4420
(360) 453-4425
Mailing address
5024 LACEY BLVD SE, LACEY, WA 98503-5729
(360) 459-4420
(360) 453-4425

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8985
WA

Other

Enumeration date
12/14/2006
Last updated
07/08/2007
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