DR. Kelissa L Peterson, DMD

NPI #1861047284 in Streator, Illinois

Provider Information

NPI Number: 1861047284
Entity Type: Individual
Name: DR. Kelissa L Peterson, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Credential: DMD
Enumeration Date: Aug 2, 2019
Last Updated: Aug 2, 2019

Practice Location

Address: 318 N BLOOMINGTON ST
City: Streator
State: Illinois
ZIP Code: 61364-2218
Phone: (815) 672-2647

Specialties & Taxonomy Codes

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

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