DR. Bryan James Petersen, D.D.S.

NPI #1205994373 in Grangeville, Idaho

Provider Information

NPI Number: 1205994373
Entity Type: Individual
Name: DR. Bryan James Petersen, D.D.S.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Credential: D.D.S.
Enumeration Date: Dec 4, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 120 N A ST
City: Grangeville
State: Idaho
ZIP Code: 83530-1211
Phone: (208) 983-1651

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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