Organization
PETERSEN FAMILY DENTAL CLINIC PA
Active
Other names
Elko-New Market Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN BLAINE PETERSEN D.D.S. (OWNER)
(952) 469-2818
Entity
Organization
Contact information
Practice address
9202 202ND ST W, SUITE 201, LAKEVILLE, MN 55044-7915
(952) 469-2818
(952) 469-2566
Mailing address
9202 202ND ST W, SUITE 201, LAKEVILLE, MN 55044-7915
(952) 469-2818
(952) 469-2566
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10525
MN
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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