Active NPI
David Eugene Peterson, DDS
- Dentist
- Redfield, SD
National Provider Identifier
1033279484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- M-434
- Practice address
- 17267 W 3Rd St
SDDC
Redfield, SD 57469-1001 - Phone
- (605) 472-4232
- Fax
- (605) 472-4439
- NPI assigned
- Dec 8, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | M-434 | SD | Primary |
Addresses
Primary practice location
17267 W 3Rd St
SDDC
Redfield, SD 57469-1001
Mailing address
16605 Ashton Dr
Ashton, SD 57424-6105
Phone (605) 472-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151207001716 | SD | Order and Referring Only - Dentist | 2062712466 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Dakota Developmental Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Intellectual Disabilities Intermediate Care Facility
- Redfield, SD
- NPI 1548391022
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033279484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16605 ASHTON DR",
"city": "ASHTON",
"state": "SD",
"postal_code": "574246105",
"telephone_number": "605-472-2400",
"fax_number": "605-472-4439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17267 W 3RD ST",
"address_2": "SDDC",
"city": "REDFIELD",
"state": "SD",
"postal_code": "574691001",
"telephone_number": "605-472-4232",
"fax_number": "605-472-4439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DAVID",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SD",
"license": "M-434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redfield, SD
- Haley Nicole Mason, CNP
- Shelby Mehlberg
- Miller Drug Inc
- Lynette Kay Munce, PAC
- Kathryn Grace Paulson
- Redfield Care and Rehabilitation Center LLC (Redfield Care and Rehabilitation Center)
- Redfield Chiropractic PC
- Redfield Drake Family Dentistry PC
- Redfield School District
- Redfield SD Skilled Nursing Facility LLC (Avantara Redfield)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.