Individual
JORDAN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1300 N DUTTON AVE, SANTA ROSA, CA 95401-7112
(707) 303-3395
Mailing address
1300 N DUTTON AVE, SANTA ROSA, CA 95401-7112
(415) 246-8524
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
RDH32940
CA
Other
Enumeration date
09/24/2019
Last updated
02/03/2022
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