Jessica Peterson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14758 Issued in MN

Practice address

25477 Main St # Po454
Nisswa, MN 56468-5001

Phone

(218) 963-6330

NPI assigned

Jun 13, 2022

Sex

Female

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

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.

• Luke Waln Dentistry, PC

  • Dentist
  • Nisswa, MN
  • NPI 1427680040
  NPD
• Staples Smiles

  • Dentist
  • Staples, MN
  • NPI 1063172468
  NPD (past)
• Zachary J Bailey DDS Inc

  • Dentist
  • Staples, MN
  • NPI 1174812689
  NPD (past)

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

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1003546128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25477 MAIN ST # PO454",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "564685001",
            "telephone_number": "218-963-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25477 MAIN ST # PO454",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "564685001",
            "telephone_number": "218-963-6330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 6th St NE",
            "address_purpose": "LOCATION",
            "city": "Staples",
            "state": "MN",
            "postal_code": "564792359",
            "country_code": "US",
            "telephone_number": "218-894-1941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JESSICA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-13",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern Hope Better Balance
• Northern Hope Functional Neurology and Chiropractic
• Partners in Conversation
• Paul Perpich, DDS
• Paul M Perpich, DDS
• Heather Noel Pierce
• Pine River Eye Center, Inc.
• John Charles Redebaugh, D.C.
• Mallori Ann Sheik, LICSW
• Susan M Slater, EDD- DR OF EDUCATION

• Dentist in Nisswa, MN
• Providers in Nisswa, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.