Individual
DR. GORDON CHARLES PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2701 1ST AVE SE, CEDAR RAPIDS, IA 52402-4834
(319) 364-5561
(319) 364-1717
Mailing address
2701 1ST AVE SE, CEDAR RAPIDS, IA 52402-4834
(319) 364-5561
(319) 364-1717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6573
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0500744
—
IA
Enumeration date
05/15/2008
Last updated
05/15/2008
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