NPIMap

Organization Active NPI

Julian Petersen DDS PLLC

  • Dental Clinic/Center
  • Richland, WA
National Provider Identifier
1316613193
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
JULIAN PETERSEN DDS PLLC
Doing business as
Smart Dental
Practice address
3200 Duportail St Ste 105
Richland, WA 99352-6105
Phone
(509) 492-2051
NPI assigned
Aug 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
Julian F Petersen, DDSNPI 1316175185
Title
Dentist/Proprietor
Phone
(925) 548-5936

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

3200 Duportail St Ste 105
Richland, WA 99352-6105

Mailing address

3200 Duportail St Ste 105
Richland, WA 99352-6105
Phone (509) 492-2051

Other names 1

  • Smart Dental Doing business as

National Provider Directory

National Provider Directory

Locations

3200 Duportail St
Ste 105
Richland, WA 99352
Phone (509) 492-2051

Practitioners & affiliated clinicians

Practitioners 1

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": "1629417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1316613193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 DUPORTAIL ST STE 105",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993526105",
            "telephone_number": "509-492-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 DUPORTAIL ST STE 105",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993526105",
            "telephone_number": "509-492-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JULIAN PETERSEN DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JULIAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DENTIST/PROPRIETOR",
        "authorized_official_telephone_number": "925-548-5936",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smart Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Smart Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.