Wayne Peterson Dmd PC

NPI #1134389281 in Moscow, Idaho

Provider Information

NPI Number: 1134389281
Entity Type: Organization
Organization Name: Wayne Peterson Dmd PC
Primary Specialty: Dentist
Enumeration Date: Jun 12, 2008
Last Updated: Jun 12, 2008

Practice Location

Address: 1138 WEST A ST
City: Moscow
State: Idaho
ZIP Code: 83843
Phone: (208) 882-9310

Authorized Official

Name: DR. WAYNE MICHAEL PETERSON, DMD
Title: PRESIDENT
Phone: (208) 882-9310

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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