Provider Demographics
NPI:1548419229
Name:ZEHREN, PETER J (DR)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:ZEHREN
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6570
Mailing Address - Country:US
Mailing Address - Phone:507-457-3333
Mailing Address - Fax:507-457-9485
Practice Address - Street 1:702 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6570
Practice Address - Country:US
Practice Address - Phone:507-457-3333
Practice Address - Fax:507-457-9485
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
10527OtherDELTA
MN4961242-00Medicaid
411948000OtherBLUE CROSS BLUE SHIELD
MN4961242-00Medicaid