Valley Oral & Facial Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

VALLEY ORAL & FACIAL SURGERY PC

Practice address

1165 S Columbia Rd Ste C
Grand Forks, ND 58201-4007

Phone

(701) 772-7379

Fax

(701) 772-9643

NPI assigned

Apr 1, 2014

Last updated

May 19, 2014By 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. Troy Richard Petersen, DMD MDNPI 1073697157

Title

President

Phone

70017727379

Specialties & licenses 1

Addresses

Other identifiers 3

Tax ID family

Valley Oral Facial Surgery PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Valley Oral & Facial Surgery PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Fargo, ND
  • NPI 1396978136
  NPD tax ID
• Valley Oral & Facial Surgery PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Grand Forks, ND
  • NPI 1801959788
  NPD tax ID

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.

• Troy R Petersen, DMD MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Forks, ND
  • NPI 1073697157
  NPD (past) Authorized official

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400457600000",
    "number": "1093133696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3187 BLUESTEM DR STE 4",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580788008",
            "telephone_number": "701-235-7379",
            "fax_number": "701-235-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 S COLUMBIA RD STE C",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014007",
            "telephone_number": "701-772-7379",
            "fax_number": "701-772-9643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY ORAL & FACIAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-01",
        "last_updated": "2014-05-19",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "70017727379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41399",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "497449200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14082",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shifteh Vahidi, MD
• Valley Bone and Joint Clinic PC
• Valley Diagnostics
• Valley Homes and Services (Valley Eldercare Center)
• Valley Med Flight Inc
• Valley Oral & Facial Surgery PC
• Valley Vision Clinic LTD
• Traci Van Beek
• Dolores I Van Bourgondien, ANP-BC
• Lauren Van Winkle

• Oral and Maxillofacial Surgery (Dentist) in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; 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.