Individual
JESSICA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
25477 MAIN ST # PO454, NISSWA, MN 56468-5001
(218) 963-6330
Mailing address
25477 MAIN ST # PO454, NISSWA, MN 56468-5001
(218) 963-6330
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14758
MN
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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