| Valley Oral & Facial Surgery Pc | |
|
1165 S Columbia Rd Ste C Grand Forks ND 58201-4007 | |
| (701) 772-7379 | |
| (701) 772-9643 |
| Full Name | Valley Oral & Facial Surgery Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1165 S Columbia Rd Ste C, Grand Forks, North Dakota |
| Authorized Official Name and Position | Troy Richard Petersen (PRESIDENT) |
| Authorized Official Contact | 70017727379 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Valley Oral & Facial Surgery Pc 3187 Bluestem Dr Ste 4 West Fargo ND 58078-8008 Ph: (701) 235-7379 | Valley Oral & Facial Surgery Pc 1165 S Columbia Rd Ste C Grand Forks ND 58201-4007 Ph: (701) 772-7379 |
| NPI Number | 1093133696 |
|---|---|
| Provider Enumeration Date | 04/01/2014 |
| Last Update Date | 05/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093133696 | NPI | - | NPPES |
| 497449200 | Medicaid | MN | |
| 41399 | Medicaid | ND | |
| 14082 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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