Jeffrey Ian Petersen, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36313 Issued in CA

Practice address

2448 Guerneville Rd
Santa Rosa, CA 95403-4175

Phone

(707) 579-2808

Fax

(707) 579-2877

NPI assigned

Nov 18, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1669454211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 HOP RANCH RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954037528",
            "telephone_number": "707-579-2737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2448 GUERNEVILLE RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954034175",
            "telephone_number": "707-579-2808",
            "fax_number": "707-579-2877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JEFFREY",
        "middle_name": "IAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael E Peters
• Timothy D. Peters, M.D.
• Petersen Dental Care
• Douglas Brent Petersen
• Ian Petersen, D.M.D.
• Jordan Petersen, RDH
• Susan Petersen, DMD
• William Petersen
• Alida Peterson, R.D.
• Carrie Dawn Peterson

• General Practice Dentistry in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.