| Gerald D. Petersen, D.d.s., S.c. | |
|
S22 W22660 East Broadway Ste 2b Waukesha WI 53186 | |
| (262) 548-3555 | |
| (262) 965-2826 |
| Full Name | Gerald D. Petersen, D.d.s., S.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | S22 W22660 East Broadway, Waukesha, Wisconsin |
| Authorized Official Name and Position | Gerald D. Petersen (OFFICER) |
| Authorized Official Contact | 2625483555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gerald D. Petersen, D.d.s., S.c. S22 W22660 East Broadway Ste 2b Waukesha WI 53186 Ph: (262) 548-3555 | Gerald D. Petersen, D.d.s., S.c. S22 W22660 East Broadway Ste 2b Waukesha WI 53186 Ph: (262) 548-3555 |
| NPI Number | 1558464891 |
|---|---|
| Provider Enumeration Date | 09/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558464891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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