Individual
JONATHAN MICHAEL BROWN PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
500 SE DOUGLAS AVE, ROSEBURG, OR 97470-3120
(541) 672-5721
Mailing address
2282 NW CALKINS AVE, ROSEBURG, OR 97471-1800
(801) 336-8621
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D10421
OR
Other
Enumeration date
05/03/2013
Last updated
07/14/2016
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