Individual
DR. KELISSA L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
318 N BLOOMINGTON ST, STREATOR, IL 61364-2218
(815) 672-2647
(815) 672-5201
Mailing address
2632 N 3739TH RD, SHERIDAN, IL 60551-9474
(815) 207-9735
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019032290
IL
Other
Enumeration date
08/02/2019
Last updated
08/02/2019
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