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Organization
MATTHEW J PETERSON, DDS, PA
Active
Organization
MATTHEW J PETERSON, DDS, PA
Active
Other names
Cambridge Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW J PETERSON DDS (PRESIDENT)
(763) 689-1554
Entity
Organization
Contact information
Practice address
124 1ST AVE E, CAMBRIDGE, MN 55008-1209
(763) 689-1554
Mailing address
124 1ST AVE E, CAMBRIDGE, MN 55008-1209
(763) 689-1554
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11782
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
307G4CA
BLUE CROSS BLUE SHIELD
MN
01
—
7845201
MN TAX ID #
MN
Enumeration date
10/06/2006
Last updated
08/22/2020
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