Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Haley Petersen, DDS

Individual provider General Practice Dentistry · NPI 1689480782

Haley Petersen, DDS is a Dentist in San Leandro, California. Qualified in 2024, 2 years ago. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2024
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

3081 Teagarden St
San Leandro, CA 94577-5720
Phone: (510) 347-4620
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence DDS110940 (CA)

Record details

NPI number1689480782
Entity typeIndividual (Type 1)
GenderFemale
Credentials DDS
Sole proprietorNo
NPI enumeratedDecember 4, 2024
Last updated in NPPESDecember 4, 2024
Certification dateDecember 3, 2024
Mailing address474 Vista Ct, Benicia, CA 94510-2716

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDENTIST
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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