NPIMap

Organization Active NPI

Orthodontic Specialists of Madison

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Madison, WI
National Provider Identifier
1275667149
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
3613-015 Issued in WI
Legal business name
ORTHODONTIC SPECIALISTS OF MADISON
Practice address
202 S Gammon Rd
Ste. 150
Madison, WI 53717-1400
Phone
(608) 664-9500
Fax
(608) 664-9566
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Steven D. Peterson, D.D.S.,M.S.NPI 1164599791
Title
President
Phone
(608) 664-9500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 3613-015 WI Primary

Addresses

Primary practice location

202 S Gammon Rd
Ste. 150
Madison, WI 53717-1400

Mailing address

202 S Gammon Rd
Ste. 150
Madison, WI 53717-1400
Phone (608) 664-9500

National Provider Directory

National Provider Directory

Locations

202 S Gammon Rd
Ste 150
Madison, WI 53717
Phone (608) 664-9500

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275667149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 S GAMMON RD",
            "address_2": "STE. 150",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171400",
            "telephone_number": "608-664-9500",
            "fax_number": "608-664-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S GAMMON RD",
            "address_2": "STE. 150",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171400",
            "telephone_number": "608-664-9500",
            "fax_number": "608-664-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHODONTIC SPECIALISTS OF MADISON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "608-664-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S.,M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WI",
            "license": "3613-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.