Organization
COMMUNITY DENTAL CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VACHAREE S PETERSON D.D.S (CEO)
(651) 925-8400
Entity
Organization
Contact information
Practice address
1670 BEAM AVE, MAPLEWOOD, MN 55109
(651) 925-8400
(651) 925-8439
Mailing address
1670 BEAM AVE, MAPLEWOOD, MN 55109
(651) 925-8400
(651) 925-8439
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
460668000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1557
HEALTHPARTNER
MN
Enumeration date
11/28/2007
Last updated
06/24/2014
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