Individual
DR. JOHN ROBERT PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4555 ERIN DR, EAGAN, MN 55122-3398
(651) 681-9044
(651) 681-0599
Mailing address
3200 HILLDALE AVE NE, ST ANTHONY, MN 55418-2502
(612) 790-3615
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D13993
MN
Other
Enumeration date
05/15/2019
Last updated
05/15/2019
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