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Organization
MICHAEL J. PETERSEN, D.D.S., P.A.
Active
Organization
MICHAEL J. PETERSEN, D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J. PETERSEN DDS (OWNER, DENTIST)
(651) 636-0840
Entity
Organization
Contact information
Practice address
3101 OLD HIGHWAY 8 STE 303, ROSEVILLE, MN 55113-1076
(651) 636-0840
Mailing address
3101 OLD HIGHWAY 8 STE 303, ROSEVILLE, MN 55113-1076
(651) 636-0840
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/05/2020
Last updated
06/05/2020
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