Provider Demographics
NPI:1033279484
Name:PETERSON, DAVID EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:SD
Mailing Address - Zip Code:57424-6105
Mailing Address - Country:US
Mailing Address - Phone:605-472-2400
Mailing Address - Fax:605-472-4439
Practice Address - Street 1:17267 W 3RD ST
Practice Address - Street 2:SDDC
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-1001
Practice Address - Country:US
Practice Address - Phone:605-472-4232
Practice Address - Fax:605-472-4439
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist