Most Relevant Information
Provider Data
| NPI Number: | 1003052606 |
| Provider Name: | FLAVIANE PETERSEN D.D.S. |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 49636 |
Most Important Dates
| Enumeration Date: | 01/02/2009 |
| Last Updated: | 01/02/2009 |
Provider Practice Location
1258 COLOMA WAY
ROSEVILLE
CA
956614602
Practice Location Phone/Fax
| Phone: | 9167841144 |
| Fax: | 9167862409 |
Provider Mailing Location
1258 COLOMA WAY
ROSEVILLE
CA
956614602
Provider Mailing Phone/Fax
| Phone: | 9167841144 |
| Fax: | 9167862409 |