Individual
JON E PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4076 3RD AVE # SU.201, SAN DIEGO, CA 92103-2129
(619) 298-2322
Mailing address
4076 3RD AVE # SU.201, SAN DIEGO, CA 92103-2129
(619) 298-2322
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
28790
CA
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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