Individual
NATHAN PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
802 W 42ND ST, HIBBING, MN 55746
(218) 263-8381
(218) 263-8383
Mailing address
802 W 42ND ST, HIBBING, MN 55746
(218) 263-8381
(218) 263-8383
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11949
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
342163500
MN HEALTH CARE PROVIDER
MN
01
—
780S4PE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
03/27/2007
Last updated
08/22/2020
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