NPIMap

Organization Active NPI

Peterson Dental Group, PC

  • Dentist
  • Reno, NV
National Provider Identifier
1174006373
Registry record updated Aug 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PETERSON DENTAL GROUP, PC
Practice address
6360 Mae Anne Ave Ste 3
Reno, NV 89523-4719
Phone
(775) 823-5100
Fax
(877) 725-7443
NPI assigned
Sep 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2025

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

Authorized official

Name
Dr. Bradley R Peterson, DDS
Title
Owner/President
Phone
(360) 869-7645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

6360 Mae Anne Ave Ste 3
Reno, NV 89523-4719

Mailing address

PO Box 872710
Vancouver, WA 98687-2710
Phone (360) 869-7645

Other names 1

  • Gentle Dental Reno Northwest Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Gentle Dental Charleston13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6360 Mae Anne Ave
Ste 3
Reno, NV 89523
Phone (775) 823-5100

NPI Registry JSON

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755820800000",
    "number": "1174006373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 872710",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986872710",
            "telephone_number": "360-869-7645",
            "fax_number": "877-725-7443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 MAE ANNE AVE STE 3",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895234719",
            "telephone_number": "775-823-5100",
            "fax_number": "877-725-7443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-13",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "360-869-7645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentle Dental Reno Northwest",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gentle Dental Reno Northwest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; 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.