Petersen, Thomas Rudolph

Petersen, Thomas Rudolph is an individual health care provider with primary practice located at 1501 Plover St , Stevens Point WI 54481. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Petersen, Thomas Rudolph can be contacted via phone (715) 344-2324.

Contact Information

Primary practice address
1501 Plover St Stevens Point WI 54481
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X WI1187G Wisconsin

Profile Details

NPI number 1437224094
LBN Legal business name Petersen, Thomas Rudolph
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2006
Last updated Jul 8th, 2007 - about 19 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 1437224094 NPPES
Wisconsin MEDICAID 33564600

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