Active NPI
Gary R Peterson, DMD, MPH
- Dentist
- Buzzards Bay, MA
National Provider Identifier
1437348109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 14376
- Practice address
- 258 Main St
Suite C 1
Buzzards Bay, MA 02532-3222 - Phone
- (508) 759-2721
- Fax
- (508) 759-6216
- NPI assigned
- Oct 18, 2007
- Last updated
- Oct 18, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 14376 | MA | Primary |
Addresses
Primary practice location
258 Main St
Suite C 1
Buzzards Bay, MA 02532-3222
Mailing address
258 Main St
Suite C 1
Buzzards Bay, MA 02532-3222
Phone (508) 759-2721
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38-768 | Other | MA | HARVARD PILGRIM HTHCARE |
| 441 | Other | MA | DELTA DENTAL OF MA |
| 711889 | Other | MA | UNITED CONCORDIA |
| X11460 | Other | MA | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 14376 | MA | MD | Oncology Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canal Side Family Dental Care, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Buzzards Bay, MA
- NPI 1780775544
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192665600000",
"number": "1437348109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "258 MAIN ST",
"address_2": "SUITE C 1",
"city": "BUZZARDS BAY",
"state": "MA",
"postal_code": "025323222",
"telephone_number": "508-759-2721",
"fax_number": "508-759-6216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "258 MAIN ST",
"address_2": "SUITE C 1",
"city": "BUZZARDS BAY",
"state": "MA",
"postal_code": "025323222",
"telephone_number": "508-759-2721",
"fax_number": "508-759-6216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GARY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DMD, MPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-18",
"last_updated": "2007-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "14376",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HTHCARE",
"identifier": "38-768",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL OF MA",
"identifier": "441",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "711889",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "X11460",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buzzards Bay, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.