NPIMap

Organization Active NPI

Petersen Family Dental Clinic PA

  • General Practice Dentistry
  • Lakeville, MN
National Provider Identifier
1720199953
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D10525 Issued in MN
Legal business name
PETERSEN FAMILY DENTAL CLINIC PA
Practice address
9202 202ND St W
Suite 201
Lakeville, MN 55044-7915
Phone
(952) 469-2818
Fax
(952) 469-2566
NPI assigned
Aug 31, 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. Steven Blaine Petersen, D.D.S.NPI 1184840365
Title
Owner
Phone
(952) 469-2818

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D10525 MN Primary

Addresses

Primary practice location

9202 202ND St W
Suite 201
Lakeville, MN 55044-7915

Mailing address

9202 202ND St W
Suite 201
Lakeville, MN 55044-7915
Phone (952) 469-2818

Other names 1

  • Elko-New Market Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Elko-New Market Dental Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

9202 202nd St W
Ste 201
Lakeville, MN 55044
Phone (952) 469-2818

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720199953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9202 202ND ST W",
            "address_2": "SUITE 201",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447915",
            "telephone_number": "952-469-2818",
            "fax_number": "952-469-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9202 202ND ST W",
            "address_2": "SUITE 201",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447915",
            "telephone_number": "952-469-2818",
            "fax_number": "952-469-2566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN FAMILY DENTAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "BLAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-469-2818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elko-New Market Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeville, 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.