Individual
DR. PETER P. DETTLAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3900 S. BROADWAY ST., MINOT, ND 58701-7534
(701) 839-8726
Mailing address
PO BOX 1165, WASHBURN, ND 58577-1165
(701) 462-8656
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
399
ND
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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