Robert Todd Petersen, DDS
Individual provider Active NPI General Practice Dentistry · Spring Creek, NV
NPI 1073994752 · NPPES record last updated Jul 9, 2015
Key facts
- NPI
- 1073994752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 9429631-9921 (UT)
- Practice address
- 282 Spring Creek Pkwy Ste 202
Spring Creek, NV 89815-5822 - Phone
- (405) 882-9174
- NPI assigned
- Jun 18, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9429631-9921 | UT | MD | General Practice Dentistry |
Networks
- UT PPO D-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9429631-9921 | UT | Yes |
Addresses
Primary practice location
282 Spring Creek Pkwy Ste 202
Spring Creek, NV 89815-5822
Mailing address
356 Royal Oak Cir
Spring Creek, NV 89815-7127
Phone (405) 882-9174
Other providers in Spring Creek, NV
- Marina Hills Dental, LLC
- Randy A Mauldin
- Clynt McCauley
- Kennedy McGuire
- Katelyn Noreen
- Sheryle Pierce
- Misty Purper
- Gerald Paul Rampton
- Ridley'S Family Markets, Inc
- Julie Rowan
All providers in Spring Creek, NV · General Practice Dentistry in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.