Peterson Dental PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PETERSON DENTAL PA

Practice address

1579 Hamline Ave N
Saint Paul, MN 55108-6119

Phone

(651) 646-8851

Fax

(651) 646-4477

NPI assigned

May 19, 2021

Last updated

May 19, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Donald Peterson, DDSNPI 1609935097

Title

Owner

Phone

(651) 646-8851

Specialties & licenses 1

Addresses

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.

• Donald Joseph Peterson, DDS

  • Dentist
  • Falcon Heights, MN
  • NPI 1609935097
  NPD Authorized official

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1669046199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1579 HAMLINE AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551086119",
            "telephone_number": "651-646-8851",
            "fax_number": "651-646-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1579 HAMLINE AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551086119",
            "telephone_number": "651-646-8851",
            "fax_number": "651-646-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-646-8851",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karl John Petersen, DDS
• Katherine A Petersen, C.N.P.
• Linda Louise Petersen, RN, BSN
• Mitchell Petersen
• Peterson & Peterson DDS PA
• Abigail Ellen Peterson, M.D.
• Amanda Flowers Peterson
• Amanda Vancene Peterson, AGACNP
• Barbara Jean Peterson, N.P.
• Barbara Lynn Peterson, PA

• Dental Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.