Individual
DR. JACOB PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 355-2165
(704) 355-8856
Mailing address
1315 EAST BLVD UNIT 230, CHARLOTTE, NC 28203-5999
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/28/2026
Last updated
04/28/2026
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