Individual
DR. BENJAMIN ROBERT PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
424 SOUTH ST., WATERLOO, IA 50701
(319) 234-2684
(319) 233-5974
Mailing address
424 SOUTH ST., WATERLOO, IA 50701
(319) 234-2684
(319) 233-5974
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D12600
MN
1223G0001X
General Practice Dentistry
Primary
08702
IA
1223G0001X
General Practice Dentistry
D12600
MN
Other
Enumeration date
07/29/2008
Last updated
10/04/2010
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