William H Peterson, DDS
Individual provider Active NPI Dentist · Long Prairie, MN
NPI 1760428593 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1760428593
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D8478 (MN)
- Practice address
- 917 1St Ave SE
Long Prairie, MN 56347 - Phone
- (320) 732-6141
- Fax
- (320) 732-6543
- NPI assigned
- Jun 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8478 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Long Prairie Dental Clinic LLC | Dentist | Past | Accepting new patients |
| Lakeland Dental P.L.L.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D8478 | MN | Yes |
Addresses
Primary practice location
917 1St Ave SE
Long Prairie, MN 56347
Mailing address
917 1St Ave SE
Long Prairie, MN 56347
Phone (320) 732-6141
Other providers in Long Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.