Michael James Petersen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9923 Issued in MN

Practice address

3101 Old Highway 8
Suite #303
Roseville, MN 55113-1072

Phone

(651) 636-0840

Fax

(651) 633-1760

NPI assigned

Jan 25, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael J. Petersen, D.D.S., P.a.

  • Dental Clinic/Center
  • Roseville, MN
  • NPI 1053935916
  NPD Authorized official

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407902307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 OLD HIGHWAY 8",
            "address_2": "SUITE #303",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131072",
            "telephone_number": "651-636-0840",
            "fax_number": "651-633-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 OLD HIGHWAY 8",
            "address_2": "SUITE #303",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131072",
            "telephone_number": "651-636-0840",
            "fax_number": "651-633-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "(INCORPORATED)HAVE IND.#",
            "identifier": "(NEED TYPE 2 # ALSO)",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Perfect Touch Massage & Chiropractic, LTD
• Kahlil Permenter, DC
• Person to Person Home Care Limited Liability Company
• Personal Care Dentistry
• Andrea Leigh Petersen
• Alyssa Marie Peterson, L.AC.
• Annika Peterson, APRN, CNP
• Gloria J Peterson, MD
• Janelle Peterson
• Jesse Peterson, LAC

• All providers in Roseville, MN
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.