NPIMap

Organization Active NPI

Daniel Petersen DDS, Inc.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Redding, CA
National Provider Identifier
1649677915
Registry record updated Dec 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
57031 Issued in CA
Legal business name
DANIEL PETERSEN DDS, INC.
Practice address
316 Knollcrest Dr
Redding, CA 96002-0104
Phone
(530) 223-1811
Fax
(530) 223-1813
NPI assigned
Dec 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2014

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

Authorized official

Name
Daniel W Petersen, DDS
Title
Owner
Phone
(530) 223-1811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X 57031 CA Primary

Addresses

Primary practice location

316 Knollcrest Dr
Redding, CA 96002-0104

Mailing address

316 Knollcrest Dr
Redding, CA 96002-0104
Phone (530) 223-1811

Other names 1

  • Riverside O.S. Other name

National Provider Directory

National Provider Directory
Tax ID family
Daniel Petersen DDS Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417478400000",
    "number": "1649677915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 KNOLLCREST DR",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960020104",
            "telephone_number": "530-223-1811",
            "fax_number": "530-223-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 KNOLLCREST DR",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960020104",
            "telephone_number": "530-223-1811",
            "fax_number": "530-223-1813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL PETERSEN DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-02",
        "last_updated": "2014-12-02",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-223-1811",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": "57031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside O.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; 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.