Individual
DR. DANIEL W PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
316 KNOLLCREST DR, REDDING, CA 96002-0104
(530) 223-1811
(530) 223-1813
Mailing address
316 KNOLLCREST DR, REDDING, CA 96002-0104
(530) 223-1811
(530) 223-1813
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
050824
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
57031
CA
Other
Enumeration date
12/16/2006
Last updated
12/05/2014
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