Michael D Peterson Ddsmspa

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

8004 Issued in MD

Legal business name

MICHAEL D PETERSON DDSMSPA

Practice address

10301 Georgia Ave Ste 202
Silver Spring, MD 20902-5020

Phone

(301) 754-0500

Fax

(301) 754-1220

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael Dean Peterson, DDS

Title

Corporate President

Phone

(301) 754-0400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154464998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10301 GEORGIA AVE STE 202",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209025020",
            "telephone_number": "301-754-0500",
            "fax_number": "301-754-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 GEORGIA AVE STE 202",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209025020",
            "telephone_number": "301-754-0500",
            "fax_number": "301-754-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D PETERSON DDSMSPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "CORPORATE PRESIDENT",
        "authorized_official_telephone_number": "301-754-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MD",
            "license": "8004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endodontics in Silver Spring, MD
• Providers in Silver Spring, MD by specialty
• Endodontics in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.