Provider Demographics
NPI:1164599791
Name:PETERSON, STEVEN D (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S GAMMON RD
Mailing Address - Street 2:STE. 150
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1400
Mailing Address - Country:US
Mailing Address - Phone:608-664-9500
Mailing Address - Fax:608-664-9566
Practice Address - Street 1:202 S GAMMON RD
Practice Address - Street 2:STE. 150
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1400
Practice Address - Country:US
Practice Address - Phone:608-664-9500
Practice Address - Fax:608-664-9566
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3613-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics