Provider Demographics
NPI:1487675005
Name:MICHAEL T. PEDERSON, DDS
Entity Type:Organization
Organization Name:MICHAEL T. PEDERSON, DDS
Other - Org Name:STEVEN E. BILBEN, DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-547-1851
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-1389
Mailing Address - Country:US
Mailing Address - Phone:218-547-1851
Mailing Address - Fax:218-547-2261
Practice Address - Street 1:108 MICHIGAN AVENUE WEST
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484
Practice Address - Country:US
Practice Address - Phone:218-547-1851
Practice Address - Fax:218-547-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty