Individual
DR. TROY R PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MD
Contact information
Practice address
1165C SOUTH COLUMBIA ROAD, GRAND FORKS, ND 58201-4007
(701) 772-7379
(701) 772-9643
Mailing address
1165C SOUTH COLUMBIA ROAD, GRAND FORKS, ND 58201-4007
(701) 772-7379
(701) 772-9643
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1897
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12975
—
ND
01
—
252L7PE
BCBS
MN
Enumeration date
10/25/2006
Last updated
07/08/2007
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