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General NPI Number Information
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NPI Number | 1598967382
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Entity Type | Organization
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Legal Business Name | PETERS ORTHODONTIC SPECIALISTS
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 1099 HELMO AVE N STE 200
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City | OAKDALE
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State | MN
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Zip | 55128-6037
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Country | US
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Telephone | 651-578-8401
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Fax | 651-731-6836
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Provider Business Mailing Address
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Address Line | 1099 HELMO AVE N STE 200
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City | OAKDALE
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State | MN
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Zip | 55128-6037
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Country | US
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Telephone | 651-578-8401
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Fax | 651-731-6836
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. SALLY NICOLE PETERS
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Credential | D.D.S., M.S.
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Telephone | 651-578-8401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D11028
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License Number State | MN
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