Brady Todd Petersen, DMD, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

S3-366 Issued in NV

Practice address

6425 S Durango Dr Ste 120
Las Vegas, NV 89113-7113

Phone

(702) 757-5355

NPI assigned

Jun 13, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Orthobar, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Las Vegas, NV
  • NPI 1033965991
  NPD
• Michael R Wanlass DDS LTD

  • Prosthetic/Orthotic Supplier
  • Las Vegas, NV
  • NPI 1154786929
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1003346917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6425 S DURANGO DR STE 120",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891137113",
            "telephone_number": "702-757-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6425 S DURANGO DR STE 120",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891137113",
            "telephone_number": "702-757-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "BRADY",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-13",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NV",
            "license": "S3-366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Latrease Peters
• Stacy Ann Peters
• Wanda Peters
• William Harold Peters
• Anastasia Petersen, BSN, RN
• Christina Petersen
• David Petersen, M.D.
• Karlee Keene Petersen, RN
• Kevin Petersen, MD
• Rachel Marie Petersen

• Orthodontics and Dentofacial Orthopedics Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.