Gerald D Petersen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3340 Issued in WI

Practice address

S22 W22660 East Broadway #2B
Waukesha, WI 53186

Phone

(262) 548-3555

NPI assigned

Jun 29, 2007

Sex

Male

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.

• Gerald D. Petersen, D.D.S., S.C.

  • General Practice Dentistry
  • Waukesha, WI
  • NPI 1558464891
  NPD (past) Authorized official

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194922575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S41W34610 BIG OAK DR",
            "city": "DOUSMAN",
            "state": "WI",
            "postal_code": "531189721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "S22 W22660 EAST BROADWAY #2B",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53186",
            "telephone_number": "262-548-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "GERALD",
        "middle_name": "D",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Peters, MA
• Sara M Peters, PMHNP-BC
• Taylor Frances Peters
• Deborah J. Petersen, MD
• Eryn Petersen
• Greta Petersen
• Angelina Onofre Peterson, NP
• Dawn Peterson, LPN
• Katherine V Peterson, RD
• Shirley Peterson, BS

• General Practice Dentistry in Waukesha, WI
• Providers in Waukesha, WI by specialty
• General Practice Dentistry in Wisconsin

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.