Individual
JENNIFER M PETERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1901 W 21ST ST N, WICHITA, KS 67203-2106
(316) 832-2838
(316) 832-9530
Mailing address
2221 E BIJOU ST, COLORADO SPRINGS, CO 80909-8008
(719) 576-1850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
60387
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200420170B
—
KS
01
—
60387
KS STATE DENTAL LICENSE
KS
Enumeration date
01/03/2007
Last updated
09/18/2019
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