| Cambridge Dental Center | |
|
124 1st Ave E Cambridge MN 55008-1209 | |
| (763) 689-1554 | |
| Not Available |
| Full Name | Cambridge Dental Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 124 1st Ave E, Cambridge, Minnesota |
| Authorized Official Name and Position | Matthew J Peterson (PRESIDENT) |
| Authorized Official Contact | 7636891554 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cambridge Dental Center 124 1st Ave E Cambridge MN 55008-1209 Ph: (763) 689-1554 | Cambridge Dental Center 124 1st Ave E Cambridge MN 55008-1209 Ph: (763) 689-1554 |
| NPI Number | 1366539082 |
|---|---|
| Provider Enumeration Date | 10/06/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1456651553 |
|---|---|
| Medicare Enrollment ID | O20151120002393 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366539082 | NPI | - | NPPES |
| 307G4CA | Other | MN | BLUE CROSS BLUE SHIELD |
| 7845201 | Other | MN | MN TAX ID # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 11782 (Minnesota) | Primary |
| Provider Name | Matthew Joshua Peterson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1902993629 PECOS PAC ID: 1557513223 Enrollment ID: I20151123002342 |
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