Mark L. Peterson

NPI #1467611624 in Rigby, Idaho

Provider Information

NPI Number: 1467611624
Entity Type: Organization
Organization Name: Mark L. Peterson
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 3, 2008
Last Updated: Jun 3, 2008

Practice Location

Address: 127 1/2 E SHORT ST
City: Rigby
State: Idaho
ZIP Code: 83442-1422
Phone: (208) 745-6536

Authorized Official

Name: DR. MARK L PETERSON, DDS
Title: DENTIST
Phone: (208) 745-6536

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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