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Organization
VALLEY ORAL & FACIAL SURGERY PC
Active
Organization
VALLEY ORAL & FACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TROY RICHARD PETERSEN DMD MD (PRESIDENT)
70017727379
Entity
Organization
Contact information
Practice address
1165 S COLUMBIA RD STE C, GRAND FORKS, ND 58201-4007
(701) 772-7379
(701) 772-9643
Mailing address
3187 BLUESTEM DR STE 4, WEST FARGO, ND 58078-8008
(701) 235-7379
(701) 235-0977
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
04/01/2014
Last updated
05/19/2014
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