| Wayne Peterson Dmd Pc | |
|
1138 West A St Moscow ID 83843 | |
| (208) 882-9310 | |
| (208) 882-8601 |
| Full Name | Wayne Peterson Dmd Pc |
|---|---|
| Speciality | Dentist |
| Location | 1138 West A St, Moscow, Idaho |
| Authorized Official Name and Position | Wayne Michael Peterson (PRESIDENT) |
| Authorized Official Contact | 2088829310 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wayne Peterson Dmd Pc 1138 West A St Moscow ID 83843 Ph: (208) 882-9310 | Wayne Peterson Dmd Pc 1138 West A St Moscow ID 83843 Ph: (208) 882-9310 |
| NPI Number | 1134389281 |
|---|---|
| Provider Enumeration Date | 06/12/2008 |
| Last Update Date | 06/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134389281 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D1686 (Idaho) | Primary |
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