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Organization
123 BRUSH DENTAL LLC
Active
Organization
123 BRUSH DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VACHAREE SRISWAD PETERSON DDS (DENTIST)
(651) 779-4195
Entity
Organization
Contact information
Practice address
1670 BEAM AVE, STE 202, MAPLEWOOD, MN 55109
(651) 779-4195
Mailing address
1670 BEAM AVE, STE 202, MAPLEWOOD, MN 55109
(651) 779-4195
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9309
MN
Other
Enumeration date
07/02/2018
Last updated
07/02/2018
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