Katie Dawn Peterson, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2012015429 Issued in MO

Practice address

920 N Main St
Mountain Grove, MO 65711-1315

Phone

(417) 926-4910

Fax

(417) 926-4399

NPI assigned

Jun 13, 2012

Last updated

Jun 13, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Katie D. Peterson, DDS, PC

  • General Practice Dentistry
  • Mountain Grove, MO
  • NPI 1326301359
  NPD (past) Authorized official
• Samuel E Deatherage DMD PC

  • General Practice Dentistry
  • Mountain Grove, MO
  • NPI 1619040078
  NPD (past)

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339545600000",
    "number": "1033471263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 N MAIN ST",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111315",
            "telephone_number": "417-926-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 N MAIN ST",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111315",
            "telephone_number": "417-926-4910",
            "fax_number": "417-926-4399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KATIE",
        "middle_name": "DAWN",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-13",
        "last_updated": "2012-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2012015429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ozarks Medical Center (Ozarks Healthcare Mountain Grove)
• Ozarks Medical Center (Ozarks Healthcare Pharmacy Mountain Grove)
• Ozarks Medical Center (Ozarks Healthcare Wound Care Mountain Grove)
• McKenzie Lynn Peifer
• Stacy A Pelletier, OTR/L
• Matthew Aaron Pigg, O.D.
• Julie Renae Posey, LCSW
• Rachel Jacleen Powell, LPC
• Regional Services (Coxhealth School Based Telemedicine)
• Renal Care Group of the Ozarks, LLC (RCG Mountain Grove)

• General Practice Dentistry in Mountain Grove, MO
• Providers in Mountain Grove, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; 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.

Verify at the official NPI Registry.