Active NPI
John Michael Peterson, DDS
- Dentist
- Riverton, UT
National Provider Identifier
1598905929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7020843
- Practice address
- 12427 S 4000 W
Ste 200
Riverton, UT 84065 - Phone
- (801) 254-8812
- NPI assigned
- Feb 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7020843 | UT | Primary |
Addresses
Primary practice location
12427 S 4000 W
Ste 200
Riverton, UT 84065
Mailing address
8472 Oak Farms Dr
West Jordan, UT 84081-1860
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 |
|---|---|---|---|
| 7020843 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| River Crossing Dental Professional Corporation | Current | Accepting new patients |
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.
-
- Dental Clinic/Center
- Riverton, UT
- NPI 1821516063
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272585600000",
"number": "1598905929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8472 OAK FARMS DR",
"city": "WEST JORDAN",
"state": "UT",
"postal_code": "840811860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12427 S 4000 W",
"address_2": "STE 200",
"city": "RIVERTON",
"state": "UT",
"postal_code": "84065",
"telephone_number": "801-254-8812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JOHN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-25",
"last_updated": "2010-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "7020843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.