Petersen, Michael James

Petersen, Michael James is an sole proprietor health care provider with primary practice located at 3101 Old Highway 8 Suite #303, Roseville MN 55113-1072. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Petersen, Michael James can be contacted via phone (651) 636-0840.

Contact Information

Primary practice address
3101 Old Highway 8 Suite #303 Roseville MN 55113-1072
Phone: (651) 636-0840
Fax: (651) 633-1760
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 9923 Minnesota

Profile Details

NPI number 1407902307
LBN Legal business name Petersen, Michael James
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 25th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407902307 NPPES
Minnesota Other (NEED TYPE 2 # ALSO) (INCORPORATED)HAVE IND.#

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