John T Peterson DDS PC
Dentist in Kankakee, IL. Organization (NPI-2).
NPI number1437436664
StatusActive
Last updated in NPPESNov 16, 2011
Details
- NPI
- 1437436664
- Entity type
- Organization (NPI-2)
- Legal business name
- John T Peterson DDS PC
- Organization subpart
- No
- Enumeration date
- Nov 16, 2011
- Last updated
- Nov 16, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 19a14762 | IL | Yes |
Practice location
200 E Court StSuite 504
Kankakee, IL 60901-3843
Phone 815-932-3613
Mailing address
200 E Court StSuite 504
Kankakee, IL 60901-3843
Phone 815-932-3613
Authorized official
John T Peterson
Dentist
8159323613
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