Individual
MRS. KARI LEE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DENTIST DDS
Contact information
Practice address
4140 THEILMAN LANE, SUITE 208, ST CLOUD, MN 56301
(320) 252-4126
(320) 202-6507
Mailing address
4140 THEILMAN LANE, SUITE 208, ST CLOUD, MN 56301
(320) 252-4126
(320) 202-6507
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12255
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8397078
STATE ID
MN
Enumeration date
12/06/2006
Last updated
07/08/2007
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