Organization
RONALD M. PETERSON, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD MARK PETERSON DDS (PRESIDENT)
(701) 232-3379
Entity
Organization
Contact information
Practice address
3226 13TH AVE S, FARGO, ND 58103-3403
(701) 232-3379
(701) 298-0879
Mailing address
3226 13TH AVE S, FARGO, ND 58103-3403
(701) 232-3379
(701) 298-0879
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1578
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40258
—
ND
01
—
901578
DENTAL SERVICE CORPORATIO
ND
Enumeration date
05/02/2007
Last updated
08/22/2020
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