Organization
MICHAEL J. PETERSEN, D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J. PETERSEN DDS (OWNER, DENTIST)
(651) 636-0840
Entity
Organization
Contact information
Practice address
3101 OLD HIGHWAY 8 STE 303, ROSEVILLE, MN 55113-1076
(651) 636-0840
Mailing address
3101 OLD HIGHWAY 8 STE 303, ROSEVILLE, MN 55113-1076
(651) 636-0840
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/05/2020
Last updated
06/05/2020
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