Provider Demographics
NPI:1831828011
Name:AMES AND PETERSON ORTHODONTICS, PLLC.
Entity type:Organization
Organization Name:AMES AND PETERSON ORTHODONTICS, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IN-HOUSE INSURANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TORIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-359-3210
Mailing Address - Street 1:1550 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5150
Mailing Address - Country:US
Mailing Address - Phone:218-236-1322
Mailing Address - Fax:218-359-0719
Practice Address - Street 1:1550 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5150
Practice Address - Country:US
Practice Address - Phone:218-236-1322
Practice Address - Fax:218-359-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty