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General NPI Number Information
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NPI Number | 1447059019
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Entity Type | Organization
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Legal Business Name | COLLIN B PETERSON DMD DENTISTRY PLLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 10409 BONEY AVE
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City | DIBERVILLE
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State | MS
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Zip | 39540-4813
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Country | US
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Telephone | 228-216-7853
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Fax |
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Provider Business Mailing Address
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Address Line | 10409 BONEY AVE
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City | DIBERVILLE
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State | MS
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Zip | 39540-4813
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Country | US
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Telephone | 228-809-8822
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Fax | 228-400-1240
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. COLLIN PETERSON
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Credential | DMD
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Telephone | 228-216-7853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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