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Individual
NATHAN PEDERSEN
Active
Individual
NATHAN PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11949
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
342163500
MN HEALTH CARE PROVIDER
MN
01
—
780S4PE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
03/27/2007
Last updated
08/22/2020
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