NPIMap

Individual provider Active NPI

Brian R. Peterson, D.D.S.

  • General Practice Dentistry
  • Mesa, AZ
National Provider Identifier
1487766853
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D 5014 Issued in AZ
Practice address
6812 E Brown Rd
Suite 101
Mesa, AZ 85207-3757
Phone
(480) 325-3368
Fax
(480) 325-0718
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D 5014 AZ Primary

Addresses

Primary practice location

6812 E Brown Rd
Suite 101
Mesa, AZ 85207-3757

Mailing address

6812 E Brown Rd
Suite 101
Mesa, AZ 85207-3757
Phone (480) 325-3368

Other identifiers 1

IdentifierTypeStateIssuer
477754OtherAZACCESS ID

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

LicenseStateTypeSpecialty
D 5014AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Brian R. Peterson, D.D.S., PC General Practice Past Accepting new patients
Care for Kids of Arizona General Practice Past Accepting new patients
Care for Kids of Arizona, LLC General Practice Past Accepting new patients
Care for Kids of Arizona, LLC General Practice Past Accepting new patients
Squaw Peak Anesthesia Inc Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487766853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6812 E BROWN RD",
            "address_2": "SUITE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852073757",
            "telephone_number": "480-325-3368",
            "fax_number": "480-325-0718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6812 E BROWN RD",
            "address_2": "SUITE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852073757",
            "telephone_number": "480-325-3368",
            "fax_number": "480-325-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BRIAN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D 5014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACCESS ID",
            "identifier": "477754",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.