Active NPI
Christopher Peterson, DMD
- Periodontics
- San Diego, CA
National Provider Identifier
1487083895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 6056
- Practice address
- 4076 3Rd Ave
Suite 201
San Diego, CA 92103-2129 - Phone
- (619) 298-2322
- NPI assigned
- Nov 6, 2013
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 6056 | AL | Primary |
Addresses
Primary practice location
4076 3Rd Ave
Suite 201
San Diego, CA 92103-2129
Mailing address
4076 3Rd Ave
Suite 201
San Diego, CA 92103-2129
Phone (619) 298-2322
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 |
|---|---|---|---|
| 6056 | AL | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peterson and Abe | Periodontics | Past | Accepting new patients |
| Jon E Peterson D.D.S. , Apc | Periodontics | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Periodontics
- San Diego, CA
- NPI 1386736445
-
- Periodontics
- San Diego, CA
- NPI 1942604277
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474502400000",
"number": "1487083895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4076 3RD AVE",
"address_2": "SUITE 201",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032129",
"telephone_number": "619-298-2322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4076 3RD AVE",
"address_2": "SUITE 201",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032129",
"telephone_number": "619-298-2322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "CHRISTOPHER",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-11-06",
"last_updated": "2016-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AL",
"license": "6056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.