Peter S Domagala, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DEN.00203804 Issued in CO

Practice address

2323 W 2ND Ave Ste E
Durango, CO 81301-4646

Phone

(970) 403-3299

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 17, 2014 through Nov 17, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Timothy V Erdle DMD PLLC

  • Multi-Specialty Clinic/Center
  • Gurnee, IL
  • NPI 1700587342
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663459200000",
    "number": "1356415673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 W 2ND AVE STE E",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014646",
            "telephone_number": "970-403-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 W 2ND AVE STE E",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014646",
            "telephone_number": "970-403-3299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMAGALA",
        "first_name": "PETER",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2022-09-18",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021-001744",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "DEN.00203804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine A Dobson, NCMT
• Matthew Dodson, LCSW
• Meghan Doenges, LPC
• David William Dolan, L.M.T.-MASSAGE THERA
• Stephanie Jo Dolence, PHARMD
• Dominick All-Heart Wellness Center
• Joanna Beth Dominick, DNP, PMHNP-BC, FNP-C
• Peter Donahue, PTA
• Donald E Kring Jr DO PC
• Danielle Donarski, DC

• Periodontics in Durango, CO
• Providers in Durango, CO by specialty
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2022; 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.

Verify at the official NPI Registry.