Peter Frandsen Pediatric Dentistry, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PETER FRANDSEN PEDIATRIC DENTISTRY, LLC

Practice address

2 Copeland Ave Ste 203
La Crosse, WI 54603-3419

Phone

(608) 782-4054

Fax

(608) 782-2198

NPI assigned

Jan 3, 2020

Last updated

Jan 3, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Haydon

Title

Office Manager

Phone

(608) 782-4054

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1316586779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 COPELAND AVE STE 203",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546033419",
            "telephone_number": "608-782-4054",
            "fax_number": "608-782-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 COPELAND AVE STE 203",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546033419",
            "telephone_number": "608-782-4054",
            "fax_number": "608-782-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER FRANDSEN PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-03",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "HAYDON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "608-782-4054"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100094671",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane C Perrone, MA
• Grant Perschke, PHARMD
• John J Pershing, MD
• John Joseph Pesch
• Luke Oiva Pesonen, MD
• Antoinette M Peters, MD
• Timothy Lou Petersen, RN
• Bethany Lynne Peterson, PT
• Brynn Peterson, OD
• Dianne L. Peterson, BSW

• Dental Clinic/Center in La Crosse, WI
• Providers in La Crosse, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.