# RONALD M. PETERSON, DDS, PC

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

## Provider details

- **NPI number:** 1265654016
- **Authorized official:** RONALD MARK PETERSON DDS (PRESIDENT)
- **Authorized official phone:** (701) 232-3379

## Contact information

- **Practice address:** 3226 13TH AVE S, FARGO, ND 58103-3403
- **Practice address phone:** (701) 232-3379
- **Practice address fax:** (701) 298-0879
- **Mailing address:** 3226 13TH AVE S, FARGO, ND 58103-3403
- **Mailing address phone:** (701) 232-3379
- **Mailing address fax:** (701) 298-0879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1578 | ND | Yes |

## Other

- **Enumeration date:** 05/02/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 40258 | — | ND |
| 01 | — | 901578 | DENTAL SERVICE CORPORATIO | ND |