NPIMap

Organization Active NPI

Jon E Peterson D.D.S. , Apc

  • Periodontics
  • San Diego, CA
National Provider Identifier
1386736445
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
28790 Issued in CA
Legal business name
JON E PETERSON D.D.S. , APC
Practice address
4076 3Rd Ave Ste 201
San Diego, CA 92103-2129
Phone
(619) 298-2322
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

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

Authorized official

Name
Dr. Jon E Peterson, DDSNPI 1285726380
Title
President
Phone
(619) 298-2322

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
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 28790 CA Primary

Addresses

Primary practice location

4076 3Rd Ave Ste 201
San Diego, CA 92103-2129

Mailing address

4076 3Rd Ave Ste 201
San Diego, CA 92103-2129
Phone (619) 298-2322

National Provider Directory

National Provider Directory

Locations

4076 3rd Ave
Ste 201
San Diego, CA 92103
Phone (619) 292-2322

Practitioners & affiliated clinicians

Practitioners 4

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": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1386736445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4076 3RD AVE STE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032129",
            "telephone_number": "619-298-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4076 3RD AVE STE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032129",
            "telephone_number": "619-298-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JON E PETERSON D.D.S. , APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-298-2322",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "28790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.