Katie D. Peterson, DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2012015429 Issued in MO

Legal business name

KATIE D. PETERSON, DDS, PC

Practice address

920 N Main St
Mountain Grove, MO 65711-1315

Phone

(417) 926-4910

Fax

(417) 926-4399

NPI assigned

Jun 25, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Katie Dawn Peterson, DDSNPI 1033471263

Title

President

Phone

(417) 926-4910

Specialties & licenses 1

Addresses

Practitioners 1

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

• Katie Dawn Peterson, D.D.S

  • General Practice Dentistry
  • Mountain Grove, MO
  • NPI 1033471263
  NPD (past) Authorized official

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340582400000",
    "number": "1326301359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 N MAIN ST",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111315",
            "telephone_number": "417-926-4910",
            "fax_number": "417-926-4399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 N MAIN ST",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111315",
            "telephone_number": "417-926-4910",
            "fax_number": "417-926-4399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATIE D. PETERSON, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-25",
        "last_updated": "2012-06-25",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-926-4910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2012015429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elton W. Hoerning, MD
• Jody L Jarrett, LPC
• Kody Johnson, FNP
• Mary Johnson, NP
• Alisha K. Jones, FNP
• Jessica Renee King, MD
• Lorraine Kusior, LPC, NCC
• Jennifer L Lambert, D.O.
• Bethany Lawson, PTA
• Lester E Cox Medical Centers (Coxhealth Center Mountain Grove)

• General Practice Dentistry in Mountain Grove, MO
• Providers in Mountain Grove, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; 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.