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General NPI Number Information
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NPI Number | 1437320512
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Entity Type | Organization
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Legal Business Name | NATALIE PETERSON DDS FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 110 W 10TH ST
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City | DULUTH
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State | MN
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Zip | 55806-2536
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Country | US
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Telephone | 262-271-8803
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Fax |
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Provider Business Mailing Address
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Address Line | 110 W 10TH ST
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City | DULUTH
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State | MN
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Zip | 55806-2536
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Country | US
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Telephone | 262-271-8803
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATALIE ANN PETERSON
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Credential | D. D. S.
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Telephone | 262-271-8803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5600-015
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License Number State | WI
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