Individual
DR. MARK L PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
127 1/2 E SHORT ST, RIGBY, ID 83442-1422
(208) 745-6536
(208) 745-0006
Mailing address
127 1/2 E SHORT ST, RIGBY, ID 83442-1422
(208) 745-6536
(208) 745-0006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D 1758
ID
Other
Enumeration date
08/28/2006
Last updated
07/09/2007
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