Individual
DR. THOMAS JOHN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
519 CHRISTEL DR., VALDERS, WI 54245
(920) 775-4531
(920) 775-4180
Mailing address
519 CHRISTEL DR., VALDERS, WI 54245
(920) 775-4531
(920) 775-4180
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3128015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3128015
STATE LICENSE
WI
05
—
33456300
—
WI
Enumeration date
09/26/2006
Last updated
07/08/2007
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