Organization
COMMUNITY DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VACHAREE PETERSON DDS (CEO)
(651) 925-8400
Entity
Organization
Contact information
Practice address
1670 BEAM AVE, MAPLEWOOD, MN 55109-1201
(651) 925-8400
Mailing address
1670 BEAM AVE, MAPLEWOOD, MN 55109-1201
(651) 925-8400
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
H9154
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124Q00000X
—
MN
Enumeration date
12/04/2014
Last updated
12/04/2014
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