Organization
VALLEY ORAL & FACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TROY RICHARD PETERSEN DMD MD (PRESIDENT)
(701) 772-7379
Entity
Organization
Contact information
Practice address
2701 9TH AVE S STE F, FARGO, ND 58103-8712
(701) 772-7379
(701) 772-9643
Mailing address
2701 9TH AVE S STE F, FARGO, ND 58103-8712
(701) 772-7379
(701) 772-9643
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
08/27/2009
Last updated
08/27/2009
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