Craig A. Peterson, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

6941-15 Issued in WI

Practice address

6226 14TH Ave
Kenosha, WI 53143-4413

Phone

(262) 656-0044

NPI assigned

Jun 25, 2012

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340582400000",
    "number": "1467715474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 COLLEGE AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031991",
            "telephone_number": "309-236-5891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6226 14TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531434413",
            "telephone_number": "262-656-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CRAIG",
        "middle_name": "A.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2012-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6941-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bennet Petersen, MS, OTR/L
• Dawn Petersen, CSAC
• Jenny Petersen
• Kristen K Petersen, SLP
• Chelsey Ruth Peterson
• Karen A Peterson, M.D.
• Kristopher Wyllis Peterson, DC
• Mark A Peterson, PA-C
• Matthew D Peterson, PA-C
• Tina Anne-Marie Peterson, D.C.

• Dentist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.