David Norman Peterson, DDS

Key facts

NPI

1487716783

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

MN7589 (MN)

Practice address

22 2ND Ave S
Sauk Rapids, MN 56379-1408

Phone

(320) 252-7806

NPI assigned

Dec 14, 2006

Sex

Male

Sole proprietor

Yes

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 and National Provider Directory roles.

• David N Peterson, DDS PA General Practice Dentistry · Sauk Rapids, MN · NPI 1487840286
  NPD (past) Authorized official GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487716783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 237",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563790237",
            "telephone_number": "320-252-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 2ND AVE S",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563791408",
            "telephone_number": "320-252-7806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DAVID",
        "middle_name": "NORMAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "MN7589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MN7589",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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