Individual
MR. THOMAS MERLIN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
816 W ST GERMAIN ST #101, ST CLOUD, MN 56301-3511
(320) 252-2454
(320) 252-2232
Mailing address
816 W ST GERMAIN ST #101, ST CLOUD, MN 56301-3511
(320) 252-2454
(320) 252-2232
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8620
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
838318900
—
MN
Enumeration date
08/31/2006
Last updated
06/18/2014
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