Individual
DR. MICHAEL JAMES PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3101 OLD HIGHWAY 8, SUITE #303, ROSEVILLE, MN 55113-1072
(651) 636-0840
(651) 633-1760
Mailing address
3101 OLD HIGHWAY 8, SUITE #303, ROSEVILLE, MN 55113-1072
(651) 636-0840
(651) 633-1760
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9923
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
(NEED TYPE 2 # ALSO)
(INCORPORATED)HAVE IND.#
MN
Enumeration date
01/25/2007
Last updated
07/08/2007
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