Provider Demographics
NPI:1285146621
Name:PETERSON, RACHEL ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RIDGE RD STE 2N
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1567
Mailing Address - Country:US
Mailing Address - Phone:219-836-8886
Mailing Address - Fax:219-836-8846
Practice Address - Street 1:131 RIDGE RD STE 2N
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1567
Practice Address - Country:US
Practice Address - Phone:219-836-8886
Practice Address - Fax:219-836-8846
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012835A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist