Active NPI
Robert Delaine Peterson, DDS
- General Practice Dentistry
- Corning, IA
National Provider Identifier
1407010960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8710
- Practice address
- 505 8TH St
Corning, IA 50841-1403 - Phone
- (641) 322-3146
- NPI assigned
- Jul 14, 2008
- Last updated
- Feb 29, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8710 | IA | Primary |
Addresses
Primary practice location
505 8TH St
Corning, IA 50841-1403
Mailing address
505 8TH St
Corning, IA 50841-1403
Phone (641) 322-3146
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8710 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456704000000",
"number": "1407010960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 8TH ST",
"city": "CORNING",
"state": "IA",
"postal_code": "508411403",
"telephone_number": "641-322-3146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 8TH ST",
"city": "CORNING",
"state": "IA",
"postal_code": "508411403",
"telephone_number": "641-322-3146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "ROBERT",
"middle_name": "DELAINE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-14",
"last_updated": "2016-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "8710",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corning, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.