Individual
LACY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1705 SE 28TH LOOP, OCALA, FL 34471-1079
(352) 351-4412
Mailing address
2315 SE 14TH ST, OCALA, FL 34471-2644
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN26148
FL
Other
Enumeration date
06/25/2021
Last updated
08/03/2021
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