Eric L Peterson DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

049002 Issued in NY

Legal business name

ERIC L PETERSON DDS PC

Practice address

225 Scottwood Ave
Elmira Heights, NY 14903-1322

Phone

(607) 733-3616

Fax

(607) 733-1053

NPI assigned

Sep 27, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Eric Laurence Peterson, DDSNPI 1487091286

Title

President

Phone

(607) 733-3616

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eric L Peterson, DDS

  • General Practice Dentistry
  • Elmira Heights, NY
  • NPI 1487091286
  NPD (past) Authorized official

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639165384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 SCOTTWOOD AVE",
            "city": "ELMIRA HEIGHTS",
            "state": "NY",
            "postal_code": "149031322",
            "telephone_number": "607-733-3616",
            "fax_number": "607-733-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 SCOTTWOOD AVE",
            "city": "ELMIRA HEIGHTS",
            "state": "NY",
            "postal_code": "149031322",
            "telephone_number": "607-733-3616",
            "fax_number": "607-733-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIC L PETERSON DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "LAURENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "607-733-3616",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "049002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02169271",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Christopher Cronin, PT
• Allan Danziger, M.D
• Theodora M. Drabinski, RN
• Kellie Lyn Drake, RN
• Elmira Heights Central School District
• Erway Ambulance Service, Inc.
• Alissa Faber, LPN
• James Christian Ferretti, D.O.
• Finger Lakes Coordination & Care
• Amy Gee, RN

• General Practice Dentistry in Elmira Heights, NY
• Providers in Elmira Heights, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.