Provider Demographics
NPI:1568547578
Name:PETERSON, HOWARD CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:CHRISTIAN
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 1:3520 S SHELDON LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6121
Mailing Address - Country:US
Mailing Address - Phone:605-338-3577
Mailing Address - Fax:605-338-5082
Practice Address - Street 1:3520 S SHELDON LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6121
Practice Address - Country:US
Practice Address - Phone:605-338-3577
Practice Address - Fax:605-338-5082
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist