Peter B Iversen Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60283265 Issued in WA

Practice address

4700 42ND Ave SW Ste 555
Seattle, WA 98116-4583

Phone

(206) 935-5522

NPI assigned

Apr 22, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Peter B. Iversen Jr., DDS, PLLC.

  • Dental Clinic/Center
  • Seattle, WA
  • NPI 1093376576
  NPD Authorized official
• Kari D Chellis RDH DDS PS

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1619357514
  NPD (past)

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

{
    "created_epoch": "1303430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1386935567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3453 39TH AVE SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981163415",
            "telephone_number": "206-403-8651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 42ND AVE SW STE 555",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981164583",
            "telephone_number": "206-935-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSEN",
        "first_name": "PETER",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-22",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60283265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iskra Ivanova Ivanova, M.D.
• Katsiaryna Ivashkevich, MD
• Emily Ivers
• Jessica Anne Ivers, M.D.
• Kimberly Dawn Iversen, PA-C
• Beau Iverson, RN
• Laura Lee Iverson, LMP
• Rachel Grace Iverson
• Sydney Iverson, PHD
• Alexandra Ivey, PSY.D.

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.