| Michael J. Petersen, D.d.s., P.a. | |
|
3101 Old Highway 8 Ste 303 Roseville MN 55113-1076 | |
| (651) 636-0840 | |
| Not Available |
| Full Name | Michael J. Petersen, D.d.s., P.a. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3101 Old Highway 8 Ste 303, Roseville, Minnesota |
| Authorized Official Name and Position | Michael J. Petersen (OWNER, DENTIST) |
| Authorized Official Contact | 6516360840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael J. Petersen, D.d.s., P.a. 3101 Old Highway 8 Ste 303 Roseville MN 55113-1076 Ph: (651) 636-0840 | Michael J. Petersen, D.d.s., P.a. 3101 Old Highway 8 Ste 303 Roseville MN 55113-1076 Ph: (651) 636-0840 |
| NPI Number | 1053935916 |
|---|---|
| Provider Enumeration Date | 06/05/2020 |
| Last Update Date | 06/05/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053935916 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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