Organization
PETERSEN DENTAL CLINIC PA
Active
Other names
Elko-New Market Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN BLAINE PETERSEN DDS (OWNER)
(952) 461-5113
Entity
Organization
Contact information
Practice address
730 MAIN ST, SUITE 2, ELKO, MN 55020-9701
(952) 461-5113
Mailing address
PO BOX 136, NEW MARKET, MN 55054-0136
(952) 461-5113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10525
MN
Other
Enumeration date
05/24/2007
Last updated
07/15/2008
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