Paris Ernst Petersen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0448791 Issued in NY

Practice address

37-53 91St St
Marcia D Herrera Dentistry PC
Jackson Heights, NY 11372-7901

Phone

(718) 205-4377

Fax

(718) 205-8605

NPI assigned

Nov 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Paris Ernst Menendez Petersen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369008000000",
    "number": "1669454096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8482",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111018482",
            "telephone_number": "718-932-0946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37-53 91ST ST",
            "address_2": "MARCIA D HERRERA DENTISTRY PC",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727901",
            "telephone_number": "718-205-4377",
            "fax_number": "718-205-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "PARIS",
        "middle_name": "ERNST",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2013-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "0448791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01471874",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PARIS",
            "last_name": "MENENDEZ PETERSEN",
            "middle_name": "ERNST",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Dentist in Jackson Heights, NY
• Providers in Jackson Heights, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; 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.