Individual
DR. JOHN TERRANCE PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
200 EAST COURT STREET, SUITE 504, KANKAKEE, IL 60901-3847
(815) 932-3613
(815) 932-5332
Mailing address
200 EAST COURT STREET, SUITE 504, KANKAKEE, IL 60901-3847
(815) 932-3613
(815) 932-5332
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19A14762
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021076
FIRST COMMONWEALTH
IL
01
—
606970
UNITED CONCORDIA
IL
Enumeration date
05/27/2006
Last updated
07/08/2007
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