Peterson, Mark Edward
Peterson, Mark Edward is an sole proprietor health care provider with primary practice located at 2440 Gaynor Nw , Grand Rapids MI 49544-1830. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Peterson, Mark Edward can be contacted via phone (616) 784-8444.Contact Information
Primary practice address
2440 Gaynor Nw
Grand Rapids MI 49544-1830
Phone: (616) 784-8444
Fax: (616) 784-6912
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 13556 | Michigan |
Profile Details
| NPI number | 1528013661 |
|---|---|
| LBN Legal business name | Peterson, Mark Edward |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 24th, 2006 |
| Last updated | Mar 14th, 2019 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528013661 | NPPES |
| Michigan | MEDICAID | 124241245 | |
| Michigan | Other | D135560 |
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