Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1508422411 Individual Practitioner Male Practitioner

Dr. John Robert Petersen , DDS

Dentist - General Practice • Eagan, MN

Professional Overview & Biography Verified Profile Summary

Dr. John Petersen, DDS is a registered healthcare professional specializing in Dentist - General Practice in Eagan, MN. Practice services are available at 4555 ERIN DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4555 Erin Dr

Eagan, MN 551223398

Telephone 6516819044
Fax 6516810599
Associated Practice Facility / Clinic
🏢 Brandon Mannie D.c. Llc Facility NPI 1629135819

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Eagan, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 33.3 Yrs
Regional Practice Density
36 Specialists

Practicing in Eagan, MN (2262 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MN D13993

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Jacob Des Jardins

Dentist - General Practice

NPI 1154017432
Dr. John Mittelsteadt , DDS

Dentist - General Practice

NPI 1649371063

Doctor of Dental Surgery

NPI 1942391735

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active May 15, 2019

NPI status registered as active in NPPES database

📍
Updated Practice Location May 15, 2019

Registered at 4555 ERIN DR, EAGAN, MN 551223398 (Tel: 6516819044)

📍
Updated Business Mailing Address May 15, 2019

Registered at 3200 HILLDALE AVE NE, ST ANTHONY, MN 554182502 (Tel: 6127903615)

👤
Provider Name / Credentials Updated May 15, 2019

Recorded as JOHN PETERSEN, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 15, 2019

Dentist (License #D13993 in MN)

🟢
Initial NPI Registration & Enumeration May 15, 2019

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1508422411
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 15, 2019
Last Update: May 15, 2019
Sole Proprietor: No

Mailing Address

3200 Hilldale Ave Ne

St Anthony, MN 554182502

Phone: 6127903615

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.