Justin Scott Peterson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.00205577 Issued in CO

Practice address

7321 Balmer St BLDG 570
Hill AFB, UT 84056-5012

Phone

(801) 777-7011

NPI assigned

Mar 17, 2023

Last updated

Aug 22, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1205538071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7321 BALMER ST BLDG 570",
            "city": "HILL AFB",
            "state": "UT",
            "postal_code": "840565012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7321 BALMER ST BLDG 570",
            "city": "HILL AFB",
            "state": "UT",
            "postal_code": "840565012",
            "telephone_number": "801-777-7011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 Capehart Rd",
            "address_purpose": "LOCATION",
            "city": "Offutt AFB",
            "state": "NE",
            "postal_code": "681132160",
            "country_code": "US",
            "telephone_number": "402-294-2930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JUSTIN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-17",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00205577",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marc Allen Palmer, PH.D.
• Ashley Patterson, MS, ATC, LAT
• Jason Patterson, D.O.
• Roger Morris Pedersen, PHARMD
• Gabriel Cecil Pepper, MD
• Mark R Peterson, DO
• Julie A Pinchak, LCSW
• Pamela Sue Reeder, R.PH.
• Stephen Gerard Reinhart, O.D.
• Wanda Acuna Rivera, RD CD

• Dentist in Hill AFB, UT
• Providers in Hill AFB, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.