Active NPI
Rex J. Peterson, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Ogden, UT
National Provider Identifier
1073653689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 140013-9921
- Practice address
- 5640 Wasatch Dr Ste C
Ogden, UT 84403-4993 - Phone
- (801) 479-9443
- NPI assigned
- Feb 6, 2007
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 140013-9921 | UT | Primary |
Addresses
Primary practice location
5640 Wasatch Dr Ste C
Ogden, UT 84403-4993
Mailing address
5640 Wasatch Dr Ste C
Ogden, UT 84403-4993
Phone (801) 479-9443
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 |
|---|---|---|---|
| 140013-9921 | UT | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1073653689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5640 WASATCH DR STE C",
"city": "OGDEN",
"state": "UT",
"postal_code": "844034993",
"telephone_number": "801-479-9443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5640 WASATCH DR STE C",
"city": "OGDEN",
"state": "UT",
"postal_code": "844034993",
"telephone_number": "801-479-9443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "REX",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "UT",
"license": "140013-9921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.