NPIMap

Organization Active NPI

Peterson and Cammack, D.D.S., P.L.L.C

  • General Practice Dentistry
  • Lacey, WA
National Provider Identifier
1437494036
Registry record updated Dec 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00008985 Issued in WA
Legal business name
PETERSON AND CAMMACK, D.D.S., P.L.L.C
Practice address
5201 Corporate Center CT SE
Lacey, WA 98503-5901
Phone
(360) 459-4420
Fax
(360) 459-4425
NPI assigned
Dec 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2012

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

Authorized official

Name
Dr. Venn Roger Peterson, D.D.S.NPI 1679635056
Title
President
Phone
(360) 459-4420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DE00008985 WA Primary

Addresses

Primary practice location

5201 Corporate Center CT SE
Lacey, WA 98503-5901

Mailing address

5201 Corporate Center CT SE
Lacey, WA 98503-5901
Phone (360) 459-4420

National Provider Directory

National Provider Directory

Locations

5201 Corporate Center Ct SE
Lacey, WA 98503
Phone (360) 459-4420

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1354838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354838400000",
    "number": "1437494036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 CORPORATE CENTER CT SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035901",
            "telephone_number": "360-459-4420",
            "fax_number": "360-459-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 CORPORATE CENTER CT SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035901",
            "telephone_number": "360-459-4420",
            "fax_number": "360-459-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON AND CAMMACK, D.D.S., P.L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-07",
        "last_updated": "2012-12-07",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "VENN",
        "authorized_official_middle_name": "ROGER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-459-4420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00008985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2012; 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.