Active NPI
Natalie A Peterson, DDS
- Dentist
- Plymouth, MN
National Provider Identifier
1629046743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D11685
- Practice address
- 13550 26TH Ave N
Plymouth, MN 55441-3650 - Phone
- (651) 557-0287
- NPI assigned
- Mar 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5600015 | WI | |
| Dentist | 122300000X | D11685 | MN | Primary |
Addresses
Primary practice location
13550 26TH Ave N
Plymouth, MN 55441-3650
Mailing address
13550 26TH Ave N
Plymouth, MN 55441-3650
Phone (651) 557-0287
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 |
|---|---|---|---|
| D11685 | MN | MD | Dentist |
| 5600015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432166400000",
"number": "1629046743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13550 26TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554413650",
"telephone_number": "651-557-0287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13550 26TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554413650",
"telephone_number": "651-557-0287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "NATALIE",
"middle_name": "A",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-14",
"last_updated": "2015-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5600015",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D11685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.