Joshua Petersen

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D1231 Issued in SD

Practice address

1687 Tablerock Rd
Rapid City, SD 57701-5495

Phone

(605) 342-6652

NPI assigned

Jun 3, 2019

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Hillsview Dental, PLLC

  • Dental Clinic/Center
  • Rapid City, SD
  • NPI 1659095701
  NPD Authorized official
• Black Hills Sleep & TMJ Solutions

  • General Practice Dentistry
  • Rapid City, SD
  • NPI 1215544333
  NPD (past)

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1508424680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1687 TABLEROCK RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1687 TABLEROCK RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015495",
            "telephone_number": "605-342-6652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JOSHUA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-03",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "D1231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "D1231",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Grant Petereit, MD
• Jennifer Rae Peters, M.A.
• Kaci Peters, DIPL. AC
• Shelby Lynn Peters
• Sydney Peters, IBCLC
• Alexis Peterson
• Calista Peterson
• Casey H Peterson, MS
• Cassidy Peterson, PA-C
• Jolene Peterson, MSW LCSW PIP

• General Practice Dentistry in Rapid City, SD
• Providers in Rapid City, SD by specialty
• General Practice Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; 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.