Provider Demographics
NPI:1548339237
Name:MORSE, PEDER BARTON (DDS)
Entity type:Individual
Prefix:DR
First Name:PEDER
Middle Name:BARTON
Last Name:MORSE
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 1:1420 LONDON RD 208
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2422
Mailing Address - Country:US
Mailing Address - Phone:218-727-2349
Mailing Address - Fax:218-727-2531
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:218-727-2531
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND118251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN889453100OtherSTATE INS GRP #
MN943191800Medicare ID - Type UnspecifiedSTATE HEALTH CARE PROGRAM