NPIMap

Organization Active NPI

Matthew J Peterson, DDS, PA

Doing business as Cambridge Dental Center

  • Dental Clinic/Center
  • Cambridge, MN
National Provider Identifier
1366539082
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
11782 Issued in MN
Legal business name
MATTHEW J PETERSON, DDS, PA
Doing business as
Cambridge Dental Center
Practice address
124 1St Ave E
Cambridge, MN 55008-1209
Phone
(763) 689-1554
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Matthew J Peterson, DDS
Title
President
Phone
(763) 689-1554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 11782 MN Primary

Addresses

Primary practice location

124 1St Ave E
Cambridge, MN 55008-1209

Mailing address

124 1St Ave E
Cambridge, MN 55008-1209
Phone (763) 689-1554

Other identifiers 2

IdentifierTypeStateIssuer
307G4CAOtherMNBLUE CROSS BLUE SHIELD
7845201OtherMNMN TAX ID #

Other names 1

  • Cambridge Dental Center Doing business as

National Provider Directory

National Provider Directory

Locations

135 Opportunity Blvd S
Cambridge, MN 55008
Phone (763) 689-1554

124 1st Ave E
Cambridge, MN 55008
Phone (763) 689-1554

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366539082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 1ST AVE E",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550081209",
            "telephone_number": "763-689-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 1ST AVE E",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550081209",
            "telephone_number": "763-689-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW J PETERSON, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-689-1554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "11782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "307G4CA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN TAX ID #",
            "identifier": "7845201",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cambridge Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cambridge, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.