Andrew Gregory Peterson, DMD, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

103423 Issued in CA

Practice address

460 Champlain Dr
Claremont, CA 91711-2753

Phone

(406) 861-8844

NPI assigned

Jul 16, 2013

Last updated

Dec 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Andrew Peterson DMD Ms PC

  • Periodontics
  • Alta Loma, CA
  • NPI 1912567058
  NPD Authorized official
• Peterson Periodontics & Implantology LLC

  • Periodontics
  • Portland, OR
  • NPI 1801310008
  Authorized official Same address or phone

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608422400000",
    "number": "1619318755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 CHAMPLAIN DR",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917112753",
            "telephone_number": "406-861-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 CHAMPLAIN DR",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917112753",
            "telephone_number": "406-861-8844"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2245 Mission St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973021291",
            "country_code": "US",
            "telephone_number": "503-887-1844",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15962 Boones Ferry Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Lake Oswego",
            "state": "OR",
            "postal_code": "970354359",
            "country_code": "US",
            "telephone_number": "503-699-6569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ANDREW",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-16",
        "last_updated": "2020-12-20",
        "certification_date": "2020-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D9905",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "103423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Susana Petrosyan
• Autumn Rose Petrovsky
• Matthew Pham
• Philcare Hospice Inc
• Ava Denise Phillips, LMFT

• Periodontics in Claremont, CA
• Providers in Claremont, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2020; 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.