Donald Joseph Peterson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D10383 Issued in MN

Practice address

1579 Hamline Ave N
Falcon Heights, MN 55108-2107

Phone

(651) 646-8851

Fax

(651) 646-4477

NPI assigned

Dec 8, 2006

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

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Peterson Dental PA

  • Dental Clinic/Center
  • Saint Paul, MN
  • NPI 1669046199
  NPD Authorized official

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1609935097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 SIMPSON ST",
            "city": "FALCON HEIGHTS",
            "state": "MN",
            "postal_code": "551136145",
            "telephone_number": "651-644-9590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1579 HAMLINE AVE N",
            "city": "FALCON HEIGHTS",
            "state": "MN",
            "postal_code": "551082107",
            "telephone_number": "651-646-8851",
            "fax_number": "651-646-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DONALD",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D10383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janelle Nesbitt, PHYSICAL THERAPIST
• New Normal PT
• Martha I Palomino Tovar
• Peace Home Healthcare LLC
• Cole William Peterson, ATC
• Tam B Pham, D.D.S.
• Shamen Radcliffe, EDD, MA, MSW, MA
• Nicholas Mark Saari, DDS
• Saint Jude Hospice - Minnesota, LLC
• Samuel Schraber, DDS

• Dentist in Falcon Heights, MN
• Providers in Falcon Heights, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.