Christopher James Peterson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

1001273-15 Issued in WI

Practice address

277 N 9TH St
De Pere, WI 54115-1548

Phone

(920) 336-6594

NPI assigned

May 26, 2015

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 WI

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.

• De Pere Smiles Acquisition Company S.C.

  dba De Pere Smiles S.C.

  • General Practice Dentistry
  • De Pere, WI
  • NPI 1225568983
  NPD Authorized official
• Wisconsin Tongue Tie Institute LLC

  • Dentist
  • De Pere, WI
  • NPI 1447025127
  NPD
• James G. Fritsche DDS SC

  • General Practice Dentistry
  • De Pere, WI
  • NPI 1700809910
  NPD (past)

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

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1427437219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 GARDENIA DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138520",
            "telephone_number": "920-740-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 N 9TH ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151548",
            "telephone_number": "920-336-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CHRISTOPHER",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-26",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001273-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Pecard III, MSSW, LCSW, CEAP
• Paige Pelot
• Amy Marie Peot, OD
• Shane Michael Peot, R.N.
• Stephen Raymond Perry, DO
• Kathryn M. Peterson, LPC
• Jeremy Daneil Petroski, LCSW
• Kathleen Phelps, MS, OTR/L
• Laura Phillips, LCSW
• Nicole Jane Phillips, RN, BSN, CLC

• Dentist in De Pere, WI
• Providers in De Pere, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; 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.