DR. TROY R PETERSEN (NPI# 1073697157) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073697157 |
| Entity Type | Individual |
| Full Name | DR. TROY R PETERSEN |
| Credential | DMD MD |
| Practice Address |
1165c South Columbia Road Grand Forks ND 58201-4007 |
| Practice Telephone | 7017727379 |
| Practice Fax Number | 7017729643 |
| Mailing Telephone | 7017727379 |
| Mailing Fax Number | 7017729643 |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
1897 | ND | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 12975 | 05 | |
| MN | BCBS | 252L7PE | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760950364 | Troy Petersen | Counselor | 1680 Sky Mountain Dr Apt J144, Reno, NV 89523-6127 | 2018-11-13 |
| Street Address |
1165C SOUTH COLUMBIA ROAD |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201-4007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154405231 | Greg M Frokjer | Dentist | 1165c South Columbia Road, Grand Forks, ND 58201-4007 | 2006-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457420564 | Face and Jaw Surgeons PC | Dentist | 2845 36 Ave South, Grand Forks, ND 58201-6747 | 2006-11-06 |
| 1093133696 | Valley Oral & Facial Surgery PC | Dentist | 1165 S Columbia Rd Ste C, Grand Forks, ND 58201-4007 | 2014-04-01 |
| 1336368240 | Marcus Brian Tanabe | Dentist | 1165 S Columbia Rd Ste C, Grand Forks, ND 58201-4007 | 2007-04-25 |
| 1639248719 | Omar C Chahal | Dentist | 2845 36 Ave South, Grand Forks, ND 58201-6747 | 2006-11-06 |
| 1154405231 | Greg M Frokjer | Dentist | 1165c South Columbia Road, Grand Forks, ND 58201-4007 | 2006-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396343737 | Face and Jaw Surgeons PC | Dentist | 1517 12 Ave Ne, Jamestown, ND 58401 | 2020-10-16 |
| 1649816828 | Dr. Jeremiah J. Glosenger, PC | Dentist | 2615 Elk Dr Ste 3, Minot, ND 58701-1200 | 2019-11-21 |
| 1255759650 | Implant&maxillofacial Surgical Center | Dentist | 2224 1st Ave W Ste 2, Williston, ND 58801-6286 | 2014-04-02 |
| 1477723591 | Oral Surgery Center of Bismarck, PC | Dentist | 3117 N 14th St, Bismarck, ND 58503-0664 | 2008-03-04 |
| 1790889152 | Rudy J Schneider | Dentist | 3187 Blue Stem Dr Ste 4, West Fargo, ND 58078-8008 | 2006-09-07 |
| 1588697015 | Phillip T. Iero, M.d.,d.d.s., PC | Dentist | 416 N 6th St, Bismarck, ND 58501-4416 | 2006-07-08 |
| 1285670067 | John G Stanley | Dentist | 2331 Tyler Pkwy, Suite 4, Bismarck, ND 58503-0871 | 2006-06-21 |
| 1184667305 | Face and Jaw Surgeons PC | Dentist | 1140 W Capitol Ave, Bismarck, ND 58501-9956 | 2006-06-14 |
| 1003859117 | Joseph Richard Deatherage | Dentist | 1730 Burnt Boat Dr Ste 300, Bismarck, ND 58503-0886 | 2006-06-14 |
| 1245272277 | Trinity Health | Dentist | 2815 16th St Sw Ste 100, Minot, ND 58701-6916 | 2006-06-12 |
| Find all providers with the same taxonomy | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
Please comment or provide details below to improve the information on DR. TROY R PETERSEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.