Dr. Douglas George Petersen
Periodontist
6545 France Ave S #366
Edina
, Minnesota 55435-2131
Dr. Douglas George Petersen
Periodontist
6545 France Ave S #366
Edina
, Minnesota 55435-2131
(952) 926-2763
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About
Features
Specialties
- Periodontist
Languages spoken
- English
Location
First Address
- Dr. Douglas George Petersen
- 6545 France Ave S #366
- Edina, MN
- Zip : 55435-2131
- Phone : (952) 926-2763
Second Address
- Dr. Douglas George Petersen
- 6545 France Ave S #366
- Edina, MN
- Zip : 55435-2131
- Phone : (952) 926-2763
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0300X | Periodontist | D10423 | MN |
National Provider Identifier
| NPI | 1134208630 |
|---|---|
| Provider Name | Dr. Douglas George Petersen |
| First Address | Edina, MN 55435-2131 |
| Second Address | Edina, MN 55435-2131 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/11/2006 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.