Audrey Lauren Peterson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

58443 Issued in CA

Practice address

5277 College Ave Ste 203
Oakland, CA 94618-1437

Phone

(510) 654-2226

Fax

(510) 595-1455

NPI assigned

Oct 16, 2009

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• The Peterson-Chan Dental Group

  • General Practice Dentistry
  • Oakland, CA
  • NPI 1225274764
  NPD (past)

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

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255651200000",
    "number": "1194050617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5277 COLLEGE AVE STE 203",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946181437",
            "telephone_number": "510-654-2226",
            "fax_number": "510-595-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5277 COLLEGE AVE STE 203",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946181437",
            "telephone_number": "510-654-2226",
            "fax_number": "510-595-1455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "AUDREY",
        "middle_name": "LAUREN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-16",
        "last_updated": "2009-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "58443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felisa Petersen
• Glen W. Petersen, M.D.
• Melanie Dianne Petersen
• Scott J. Petersen, MD
• Sidney Petersen, RN
• Ayannah Nichole Peterson
• Caroline Alston Peterson, D.M.D.
• Chad Peterson, RNFA
• Dagnija M Peterson, P.T.
• Ellen Tanner Peterson, RN, CPNP, MSN

• General Practice Dentistry in Oakland, CA
• Providers in Oakland, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2009; 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.