Active NPI
Michael Scott Peterman, DMD
- Dentist
- Fort Bragg, NC
National Provider Identifier
1073615993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN013404
- Practice address
- 2817 Reilly St Stop B
USA Dental Activity MCDS NA B
Fort Bragg, NC 28310-7302 - Phone
- (910) 396-5610
- NPI assigned
- Sep 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | DN013404 | GA | Primary |
Addresses
Primary practice location
2817 Reilly St Stop B
USA Dental Activity MCDS NA B
Fort Bragg, NC 28310-7302
Mailing address
2817 Reilly St Stop B
USA Dental Activity MCDS NA B
Fort Bragg, NC 28310-7302
Phone (910) 396-5610
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN013404 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274659200000",
"number": "1073615993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 REILLY ST STOP B",
"address_2": "USA DENTAL ACTIVITY MCDS NA B",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283107302",
"telephone_number": "910-396-5610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2817 REILLY ST STOP B",
"address_2": "USA DENTAL ACTIVITY MCDS NA B",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283107302",
"telephone_number": "910-396-5610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERMAN",
"first_name": "MICHAEL",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-01",
"last_updated": "2010-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN013404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.