Individual
DR. DOUGLAS GEORGE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6545 FRANCE AVE S, #366, EDINA, MN 55435-2131
(952) 926-2763
Mailing address
6545 FRANCE AVE S, #366, EDINA, MN 55435-2131
(952) 926-2763
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D10423
MN
Other
Enumeration date
11/03/2006
Last updated
07/08/2007
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