NPIMap

Organization Active NPI

Petersen and Weller DDS PLLC

  • General Practice Dentistry
  • Bothell, WA
National Provider Identifier
1417960782
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5471 Issued in WA
Legal business name
PETERSEN AND WELLER DDS PLLC
Practice address
22833 Bothell Everett Hwy SE
Ste #205
Bothell, WA 98021
Phone
(425) 485-6540
Fax
(425) 486-1740
NPI assigned
Aug 15, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Michelle Marie Beyer
Title
Financial Coordinator
Phone
(425) 485-6540

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8485 WA
General Practice Dentistry 1223G0001X 5471 WA Primary

Addresses

Primary practice location

22833 Bothell Everett Hwy SE
Ste #205
Bothell, WA 98021

Mailing address

22833 Bothell Everett Hwy SE
Ste #205
Bothell, WA 98021
Phone (425) 485-6540

National Provider Directory

National Provider Directory

Locations

22833 Bothell Everett Hwy
Ste 205
Bothell, WA 98021
Phone (425) 485-6540

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417960782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22833 BOTHELL EVERETT HWY SE",
            "address_2": "STE #205",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "98021",
            "telephone_number": "425-485-6540",
            "fax_number": "425-486-1740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22833 BOTHELL EVERETT HWY SE",
            "address_2": "STE #205",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "98021",
            "telephone_number": "425-485-6540",
            "fax_number": "425-486-1740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN AND WELLER DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEYER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "FINANCIAL COORDINATOR",
        "authorized_official_telephone_number": "425-485-6540",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "8485",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "5471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.