Individual
DR. PETER TODD MATHISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1351 PAGE DRIVE SOUTH, SUITE 102, FARGO, ND 58103-3536
(701) 478-4500
(701) 478-4501
Mailing address
1351 PAGE DRIVE SOUTH, SUITE 102, FARGO, ND 58103-3536
(701) 478-4500
(701) 478-4501
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1933
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
450484245-00001
DELTA DENTAL OF MN
MN
01
—
901933
DSC OF ND
ND
Enumeration date
10/04/2006
Last updated
07/08/2007
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