Craig Albert Peterson, D.D.S.
Individual provider Active NPI General Practice Dentistry · Waseca, MN
NPI 1922128404 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1922128404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 7460 (MN)
- Practice address
- 1504 4TH St NE
Waseca, MN 56093 - Phone
- (507) 835-1080
- Fax
- (507) 835-1184
- NPI assigned
- Mar 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| 7460 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Waseca Dental Care, P.L.L.C. | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7460 | MN | Yes |
Addresses
Primary practice location
1504 4TH St NE
Waseca, MN 56093
Mailing address
4 Nickolay Lane
Grand Marais, MN 55604-5011
Phone (218) 387-2038
Other providers in Waseca, MN
- Jenna Murphy
- Todd Adrian Nelson
- Tiffany O'Malley
- Austin Ostrander
- Chastity Pautzke
- Phoenix Recovery Programs, Inc.
- Paige Pittmann
- David A Pope
- Rachel'S Light
- Kelsey Nicole Raddawi
All providers in Waseca, MN · General Practice Dentistry in Minnesota
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.