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General NPI Number Information
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NPI Number | 1578799375
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Entity Type | Individual
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Provider Name | WILLIAM DAVID PETERSON DDS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 2811 E COURT ST SUITE I
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City | FLINT
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State | MI
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Zip | 48506-4054
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Country | US
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Telephone | 810-232-2920
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Fax | 810-232-1054
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Provider Business Mailing Address
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Address Line | 1803 VLG GREEN BLVD APT 104
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-6109
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Country | US
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Telephone | 616-724-0412
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Fax | 810-232-1054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901020029
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License Number State | MI
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