Active NPI
Jill Peterson, DDS, MPH, PHD
- Endodontics
- Arlington, TX
National Provider Identifier
1356379739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 18969
- Practice address
- 906 N Fielder Rd
Arlington, TX 76012-3195 - Phone
- (817) 461-4292
- Fax
- (817) 276-0229
- NPI assigned
- Jun 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 18969 | TX | Primary |
Addresses
Primary practice location
906 N Fielder Rd
Arlington, TX 76012-3195
Mailing address
906 N Fielder Rd
Arlington, TX 76012-3195
Phone (817) 461-4292
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 16, 2016 through May 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18969 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356379739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "906 N FIELDER RD",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760123195",
"telephone_number": "817-461-4292",
"fax_number": "817-276-0229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "906 N FIELDER RD",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760123195",
"telephone_number": "817-461-4292",
"fax_number": "817-276-0229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JILL",
"name_prefix": "Dr.",
"credential": "DDS, MPH, PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "TX",
"license": "18969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.