Michael J. Petersen, D.D.S., P.a.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MICHAEL J. PETERSEN, D.D.S., P.A.

Practice address

3101 Old Highway 8 Ste 303
Roseville, MN 55113-1076

Phone

(651) 636-0840

NPI assigned

Jun 5, 2020

Last updated

Jun 5, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael J. Petersen, DDSNPI 1407902307

Title

Owner, Dentist

Phone

(651) 636-0840

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael James Petersen, D.D.S.

  • General Practice Dentistry
  • Roseville, MN
  • NPI 1407902307
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1053935916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 OLD HIGHWAY 8 STE 303",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131076",
            "telephone_number": "651-636-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 OLD HIGHWAY 8 STE 303",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131076",
            "telephone_number": "651-636-0840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J. PETERSEN, D.D.S., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-05",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER, DENTIST",
        "authorized_official_telephone_number": "651-636-0840",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Merriman, MD
• Metro Treatment of Minnesota LP (St Paul Metro Treatment Center)
• Benjamin Dutton Meyer, M.D.
• Thomas Joseph Meyer, OD
• Peggye Mezile
• Michael Joyce DPM PA
• Midwest Health Solutions PA (Platinum Health Solutions)
• Midwest Med Management, Inc
• Midwest Radiology, PA
• Midwest Stone Management

• Dental Clinic/Center in Roseville, MN
• Providers in Roseville, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.