Most Relevant Information
Provider Data
| NPI Number: | 1003546128 |
| Provider Name: | JESSICA PETERSON DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | D14758 |
Most Important Dates
| Enumeration Date: | 06/13/2022 |
| Last Updated: | 06/13/2022 |
Provider Practice Location
25477 MAIN ST # PO454
NISSWA
MN
564685001
Practice Location Phone/Fax
| Phone: | 2189636330 |
| Fax: |
Provider Mailing Location
25477 MAIN ST # PO454
NISSWA
MN
564685001
Provider Mailing Phone/Fax
| Phone: | 2189636330 |
| Fax: |