Provider Demographics
NPI:1912348145
Name:PETERSON, VANESSA NOEL BROWNE (DDS, MS)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:NOEL BROWNE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10165 FOOTHILL BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0341
Mailing Address - Country:US
Mailing Address - Phone:909-774-0107
Mailing Address - Fax:909-774-0107
Practice Address - Street 1:10165 FOOTHILL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0341
Practice Address - Country:US
Practice Address - Phone:909-774-0107
Practice Address - Fax:909-774-0107
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605053541223X0400X
ORD101781223X0400X
CA629241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics