Provider Demographics
NPI:1235305707
Name:PEDER B MORSE DDS, PA
Entity Type:Organization
Organization Name:PEDER B MORSE DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BECCI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SWANSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-727-2349
Mailing Address - Street 1:306 W SUPERIOR ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1803
Mailing Address - Country:US
Mailing Address - Phone:218-727-2349
Mailing Address - Fax:
Practice Address - Street 1:306 W SUPERIOR ST
Practice Address - Street 2:SUITE 601
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1803
Practice Address - Country:US
Practice Address - Phone:218-727-2349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND118251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1245309921OtherNPI
MN1548339237OtherNPI