Peterson, James

Peterson, James is an individual health care provider with primary practice located at 331 S Main St , Virginia IL 62691-1571. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dental Public Health. Dental Providers / General Practice is his primary health care specialty. Peterson, James can be contacted via phone (217) 452-3057.

Contact Information

Primary practice address
331 S Main St Virginia IL 62691-1571
Phone: (217) 452-3057
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 019029045 Illinois
Dental Providers / Dental Public Health 1223D0001X 019029045 Illinois

Profile Details

NPI number 1376806224
LBN Legal business name Peterson, James
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2012
Last updated Jun 1st, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376806224 NPPES
Illinois Other 019029045 ILLINOIS LICENSE NUMBER

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