Provider Demographics
NPI:1427549674
Name:PETERSON, WENDY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3709
Mailing Address - Country:US
Mailing Address - Phone:715-395-5393
Mailing Address - Fax:715-392-1935
Practice Address - Street 1:210 3RD ST
Practice Address - Street 2:
Practice Address - City:CARLTON
Practice Address - State:MN
Practice Address - Zip Code:55718-7703
Practice Address - Country:US
Practice Address - Phone:218-336-3524
Practice Address - Fax:218-384-9002
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10018531223G0001X
MND140181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice