# VALLEY ORAL & FACIAL SURGERY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093133696
- **Authorized official:** DR. TROY RICHARD PETERSEN DMD MD (PRESIDENT)
- **Authorized official phone:** 70017727379

## Contact information

- **Practice address:** 1165 S COLUMBIA RD STE C, GRAND FORKS, ND 58201-4007
- **Practice address phone:** (701) 772-7379
- **Practice address fax:** (701) 772-9643
- **Mailing address:** 3187 BLUESTEM DR STE 4, WEST FARGO, ND 58078-8008
- **Mailing address phone:** (701) 235-7379
- **Mailing address fax:** (701) 235-0977

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 04/01/2014
- **Last updated:** 05/19/2014