Petersen, Jeffrey Ian

Petersen, Jeffrey Ian is an individual health care provider with primary practice located at 2448 Guerneville Rd , Santa Rosa CA 95403-4175. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Petersen, Jeffrey Ian can be contacted via phone (707) 579-2808.

Contact Information

Primary practice address
2448 Guerneville Rd Santa Rosa CA 95403-4175
Phone: (707) 579-2808
Fax: (707) 579-2877
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 36313 California

Profile Details

NPI number 1669454211
LBN Legal business name Petersen, Jeffrey Ian
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2005
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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