Peter L Paulson, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

019.016569 Issued in IL

Practice address

1465 East Village Parkway
Mount Zion, IL 62549

Phone

(217) 864-9318

NPI assigned

Feb 13, 2007

Last updated

Apr 25, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335312000000",
    "number": "1124160247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 EAST VILLAGE PARKWAY",
            "city": "MOUNT ZION",
            "state": "IL",
            "postal_code": "62549",
            "telephone_number": "217-864-9318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 EAST VILLAGE PARKWAY",
            "city": "MOUNT ZION",
            "state": "IL",
            "postal_code": "62549",
            "telephone_number": "217-864-9318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "PETER",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2012-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.016569",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019016569",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mt. Zion Chiropractic Clinic LLC (Alpha Integrative Medicine)
• Mt. Zion Hearing Aid Center
• Megan Musick, M.P.T.
• Chris Nayor Ntor-Ue, DC LAC
• Julia A Paulson, D.M.D.
• Prairie Medical Supply Inc
• Russell John Proesel, DDS
• Dana Marie Ray, MD
• Jacob David Sams, MD
• Sanders Counseling PLLC

• Dentist in Mt Zion, IL
• Providers in Mt Zion, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; 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.