Individual
JACOB DEAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5000 BLACKMORE RD, CASPER, WY 82609-3345
(307) 233-6000
(307) 233-6019
Mailing address
5000 BLACKMORE RD, CASPER, WY 82609-3345
(307) 233-6000
(307) 233-6089
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1679
WY
Other
Enumeration date
03/05/2024
Last updated
01/29/2025
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