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General NPI Number Information
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NPI Number | 1629046743
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Entity Type | Individual
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Provider Name | NATALIE A PETERSON DDS
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Gender | Female
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 13550 26TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55441-3650
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Country | US
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Telephone | 651-557-0287
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Fax |
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Provider Business Mailing Address
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Address Line | 13550 26TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55441-3650
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Country | US
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Telephone | 651-557-0287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5600015
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11685
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License Number State | MN
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