Jason M Peterson, DDS

NPI #1225255748 in Idaho Falls, Idaho

Provider Information

NPI Number: 1225255748
Entity Type: Individual
Name: Jason M Peterson, DDS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - Periodontics
Credential: DDS
Enumeration Date: Apr 18, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1980 1ST ST
City: Idaho Falls
State: Idaho
ZIP Code: 83401-4342
Phone: (208) 524-3400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Periodontics — Periodontics	1223P0300X	Primary

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