NPIMap

Organization Active NPI

Dr Neil E Peterson & Assoc

  • Dentist
  • Milwaukee, WI
National Provider Identifier
1679778138
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5000681 Issued in WI
Legal business name
DR NEIL E PETERSON & ASSOC
Practice address
5019 W North Avenue
Milwaukee, WI 53208-1121
Phone
(414) 445-6600
Fax
(414) 445-6618
NPI assigned
Jun 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Neil Edward PetersonNPI 1790818094
Title
Owner
Phone
(414) 445-6600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 5000681 WI Primary

Addresses

Primary practice location

5019 W North Avenue
Milwaukee, WI 53208-1121

Mailing address

5019 W North Avenue
Milwaukee, WI 53208-1121
Phone (414) 445-6600

Other identifiers 1

IdentifierTypeStateIssuer
38375200MedicaidWI

Other names 1

  • Westgate Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

5019 W North Ave
Milwaukee, WI 53208
Phone (414) 445-6500

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679778138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5019 W NORTH AVENUE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532081121",
            "telephone_number": "414-445-6600",
            "fax_number": "414-445-6618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5019 W NORTH AVENUE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532081121",
            "telephone_number": "414-445-6600",
            "fax_number": "414-445-6618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR NEIL E PETERSON & ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-445-6600",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "5000681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38375200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westgate Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

  • 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.