Provider Demographics
NPI:1255322293
Name:PETERSON, SHELDON TRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:TRENT
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 NICOLLET AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5710
Mailing Address - Country:US
Mailing Address - Phone:952-435-4177
Mailing Address - Fax:952-898-6164
Practice Address - Street 1:14050 NICOLLET AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5710
Practice Address - Country:US
Practice Address - Phone:952-435-4177
Practice Address - Fax:952-898-6164
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist