Active NPI
Kyle W. Peterson, DDS
- Dentist
- Moline, IL
National Provider Identifier
1285947259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 08753
- Practice address
- 609 22ND St
Moline, IL 61265-1450 - Phone
- (309) 797-2001
- NPI assigned
- Jul 20, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 08753 | IA | Primary |
Addresses
Primary practice location
609 22ND St
Moline, IL 61265-1450
Mailing address
609 22ND St
Moline, IL 61265-1450
Phone (309) 797-2001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08753 | IA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Dentistry, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Moline, IL
- NPI 1427349216
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316563200000",
"number": "1285947259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "609 22ND ST",
"city": "MOLINE",
"state": "IL",
"postal_code": "612651450",
"telephone_number": "309-797-2001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "609 22ND ST",
"city": "MOLINE",
"state": "IL",
"postal_code": "612651450",
"telephone_number": "309-797-2001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KYLE",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-20",
"last_updated": "2011-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "08753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moline, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.