Peterson Dental Associates, P.A.

LBN: Peterson Dental Associates, P.A.
Peterson Dental Associates, P.A. is an health care organization with primary practice located at 816 W St Germain St #101 , St Cloud MN 56301-3511. The organization recently has 3 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dental Hygienist, Dental Providers / Dental Assistant. Dental Providers / General Practice is the primary health care specialty. Peterson Dental Associates, P.A. can be contacted via phone (320) 252-2454, or through Peterson, Russell Thomas via phone (320) 252-2454.

Contact Information

Primary practice address
816 W St Germain St #101 St Cloud MN 56301-3511
Phone: (320) 252-2454
Fax: (320) 252-2232
Website:
Map and Directions
Authorized official contact:
Name: Peterson, Russell Thomas Doctor of Dental Surgery (DDS)
Phone: (320) 252-2454

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X
Dental Providers / Dental Hygienist 124Q00000X
Dental Providers / Dental Assistant 126800000X

Profile Details

NPI number 1396856100
LBN Legal business name Peterson Dental Associates, P.A.
DBA Doing business as
Authorized official Peterson, Russell Thomas Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 31st, 2006
Last updated Jun 17th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396856100 NPPES
Minnesota MEDICAID 398350100

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