Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1956 | ND |
NPI | 1144430679 |
---|---|
Provider Name | Dr. Christine Grace Peterson |
First Address | Bismarck, ND 58503-0204 |
Second Address | Fort Yates, ND 58538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |