Active NPI
Andrea Marie Peters, D.D.S
- General Practice Dentistry
- Saint Charles, MN
National Provider Identifier
1154557932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D12702
- Practice address
- 931 Whitewater Ave
Saint Charles, MN 55972-1130 - Phone
- (507) 932-4530
- NPI assigned
- Jun 7, 2009
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D12702 | MN | Primary |
Addresses
Primary practice location
931 Whitewater Ave
Saint Charles, MN 55972-1130
Mailing address
931 Whitewater Ave
Saint Charles, MN 55972-1130
Phone (507) 932-4530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 15, 2017 through Sep 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12702 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Dental Professionals, Minnesota PC | Past | Accepting new patients | |
| Elgin Family Dentistry | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dentist
- Saint Charles, MN
- NPI 1023250503
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244332800000",
"number": "1154557932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "931 WHITEWATER AVE",
"city": "SAINT CHARLES",
"state": "MN",
"postal_code": "559721130",
"telephone_number": "507-932-4530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "931 WHITEWATER AVE",
"city": "SAINT CHARLES",
"state": "MN",
"postal_code": "559721130",
"telephone_number": "507-932-4530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "ANDREA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-07",
"last_updated": "2009-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D12702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.