Mr Ronald Lee Petersen, DDS is a
Dentist based in Charleston, Missouri. Mr Ronald Lee Petersen is licensed to practice in Missouri (license number 014068) and his current practice location is
104 North Main St, Charleston, Missouri. He can be reached at his office (for appointments etc.) via phone at
(573) 683-2101.
NPI number for Mr Ronald Lee Petersen is 1194830760 and his current mailing address is 104 North Main St, Charleston, Missouri. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1194830760.
Healthcare Provider's Profile
| Full Name | Mr Ronald Lee Petersen |
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| Gender | Male |
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| Speciality | Dentist |
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| Location | 104 North Main St, Charleston, Missouri |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1194830760
- Provider Enumeration Date: 08/21/2006
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Mr Ronald Lee Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1194830760 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 122300000X | Dentist | 014068 (Missouri) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Ronald Lee Petersen is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Ronald Lee Petersen, DDS
104 North Main St,
Charleston, MO 63834
Ph: (573) 683-2101 | Mr Ronald Lee Petersen, DDS
104 North Main St,
Charleston, MO 63834
Ph: (573) 683-2101 |
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