| John T Peterson Dds Pc | |
|
200 E Court St Suite 504 Kankakee IL 60901-3843 | |
| (815) 932-3613 | |
| Not Available |
| Full Name | John T Peterson Dds Pc |
|---|---|
| Speciality | Dentist |
| Location | 200 E Court St, Kankakee, Illinois |
| Authorized Official Name and Position | John T Peterson (DENTIST) |
| Authorized Official Contact | 8159323613 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John T Peterson Dds Pc 200 E Court St Suite 504 Kankakee IL 60901-3843 Ph: (815) 932-3613 | John T Peterson Dds Pc 200 E Court St Suite 504 Kankakee IL 60901-3843 Ph: (815) 932-3613 |
| NPI Number | 1437436664 |
|---|---|
| Provider Enumeration Date | 11/16/2011 |
| Last Update Date | 11/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437436664 | NPI | - | NPPES |
| 1003311 | Medicaid | IL | |
| 606970 | Other | IL | UNITED CONCORDIA |
| 021076 | Other | IL | FIRST COMMONWEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 19A14762 (Illinois) | Primary |
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