Individual provider · Type 1 NPI

Jacob Peterson, DMD

Student in an Organized Health Care Education/Training Program · Charlotte, NC

NPI number 1497691620 Active

Practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Call (704) 355-2165 Map

Fax (704) 355-8856

Mailing address

1315 East Blvd Unit 230
Charlotte, NC 28203-5999

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1497691620

Jacob Peterson, DMD's National Provider Identifier is 1497691620, issued on Apr 28, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Charlotte, NC. The record was last updated on Apr 28, 2026.