Austin M Peterson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12013338A Issued in IN

Practice address

3935 E Southport Rd
Indianapolis, IN 46237-3203

Phone

(317) 244-3000

NPI assigned

Aug 23, 2018

Last updated

Aug 19, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amp Dental

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1922697747
  NPD Authorized official

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1639650187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 ROLLING HILLS DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600142969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3935 E SOUTHPORT RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462373203",
            "telephone_number": "317-244-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3809 Oakwood Mall Dr",
            "address_purpose": "LOCATION",
            "city": "Eau Claire",
            "state": "WI",
            "postal_code": "547013042",
            "country_code": "US",
            "telephone_number": "715-835-5300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "AUSTIN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-23",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001921-15",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12013338A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew James Petersen, M.D.
• Zinaida Petersen
• Kelly Ann Petersohn, LCSW
• Greta P Peterson Clement, NP
• Ana Peterson
• Cheryl Peterson, B.S. PHARMACY
• Christian Peterson
• Donna Peterson, PTA
• Ellen Louise Peterson, MD
• Emily Peterson

• Dentist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.