Healthcare Provider Details

I. General information

NPI: 1821101882
Provider Name (Legal Business Name): ROBERT H PETERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 MEXICO RD SUITE 202
SAINT PETERS MO
63376-1369
US

IV. Provider business mailing address

12502 WINDSOR VIEW CT
SAINT LOUIS MO
63141-6380
US

V. Phone/Fax

Practice location:
  • Phone: 636-970-7902
  • Fax: 636-970-3359
Mailing address:
  • Phone: 314-432-5544
  • Fax: 314-432-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2001022064
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: