Dale Robert Peterson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

588 Issued in WY

Practice address

555 S 5TH St
Lander, WY 82520-3245

Phone

(307) 332-9193

NPI assigned

Mar 7, 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 WY

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

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164552048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 S 5TH ST",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203245",
            "telephone_number": "307-332-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 S 5TH ST",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203245",
            "telephone_number": "307-332-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DALE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WY",
            "license": "588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Sialia Parr, B.S. IN ED.
• Path Behavioral Health Wyoming LLC
• Sarah Jane Penn, APRN, FNP-C
• Tonya Pepper
• Christopher R Peterson, DDS
• Megan M. Peterson, PHARMD
• Kathleen Ann Petro, FNP-BC
• Tras Steven Pfeifer, PA-C, MPAS
• Royce James Philpott, PHARMD, RPH
• Douglas Rex Phipps, M.D.

• Dentist in Lander, WY
• Providers in Lander, WY by specialty
• Dentist in Wyoming

• 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.