Healthcare Provider Details

I. General information

NPI: 1922932581
Provider Name (Legal Business Name): RHETT THOMAS PEDERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 2ND AVE SW STE 24
MINOT ND
58701-3459
US

IV. Provider business mailing address

1600 2ND AVE SW STE 24
MINOT ND
58701-3459
US

V. Phone/Fax

Practice location:
  • Phone: 701-838-8399
  • Fax:
Mailing address:
  • Phone: 701-838-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2589
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: