Mark A Peterson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN0011508 Issued in FL

Practice address

7740 Bay St
Suite # 1
Sebastian, FL 32958-3427

Phone

(772) 388-3119

Fax

(722) 388-0250

NPI assigned

Oct 4, 2006

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

State licenses

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1073608170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4280 BERRY RD",
            "city": "GRANT",
            "state": "FL",
            "postal_code": "329495323",
            "telephone_number": "321-722-9474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7740 BAY ST",
            "address_2": "SUITE # 1",
            "city": "SEBASTIAN",
            "state": "FL",
            "postal_code": "329583427",
            "telephone_number": "772-388-3119",
            "fax_number": "722-388-0250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN0011508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marza Smith Penny, M.D.
• Gabriella Rae Perez, PHARMD
• Naomi Dawn Perri, ARNP-C
• Rebecca Pesina, 5219 DO
• Peter M. Gutierrez, D.D.S. and Katherine Scures-Gutierrez, D.D.S., P.a
• William Russell Phipps, M.D.
• Patrick W Pirkle, DMD
• Podiatry Associates of Indian River County, LLC
• Sara Kendall Polito, MSN, APRN, FNP-C
• Jennifer Poulos

• General Practice Dentistry in Sebastian, FL
• Providers in Sebastian, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.