Brian Jon Petersburg, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901010174 Issued in MI

Practice address

8641 W Grand River Ave
Suite 6
Brighton, MI 48116-4353

Phone

(810) 227-4224

Fax

(810) 227-4660

NPI assigned

Apr 2, 2007

Sex

Male

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 MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Livingston Dental Sleep Therapy PLLC

  • Dentist
  • Brighton, MI
  • NPI 1629414255
  NPD (past) Authorized official

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083734958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 BRIGHTON RD",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481169742",
            "telephone_number": "810-227-5874",
            "fax_number": "810-227-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8641 W GRAND RIVER AVE",
            "address_2": "SUITE 6",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481164353",
            "telephone_number": "810-227-4224",
            "fax_number": "810-227-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSBURG",
        "first_name": "BRIAN",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901010174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Periodontal Specialists Group
• Ignazio Dominic Perna, DPM
• Perspectives Therapy Services LLC
• Peter M Lisiecki PHD PC Inc
• Michael Joseph Peters, PA-C
• Jay William Peterson, PA-C
• Physiotherapy Associates Inc
• Taylor Bell Picano, CCC-SLP
• Tanuka Datta Piech, MD
• Brita Pietila, LPN

• General Practice Dentistry in Brighton, MI
• Providers in Brighton, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.