Collin Peterson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

4197-21 Issued in MS

Practice address

10409 Boney Ave
Diberville, MS 39540-4813

Phone

(228) 809-8822

Fax

(228) 400-1240

NPI assigned

Jun 8, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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 and National Provider Directory roles.

• Collin B Peterson DMD Dentistry PLLC

  • General Practice Dentistry
  • Diberville, MS
  • NPI 1447059019
  NPD Authorized official
• Compton Healthcare Inc

  • Internal Medicine Physician
  • Gulfport, MS
  • NPI 1447431598
  NPD (past)
• PFD LLC

  • Dentist
  • Gulfport, MS
  • NPI 1558816181
  NPD (past)

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770854400000",
    "number": "1689241697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10409 BONEY AVE",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395404813",
            "telephone_number": "228-809-8822",
            "fax_number": "228-400-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10409 BONEY AVE",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395404813",
            "telephone_number": "228-809-8822",
            "fax_number": "228-400-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "COLLIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-08",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "4197-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Morgan Parrish
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• Gretchen Petrie Graff, M.A., LPC
• Diem Hong Phan, PHARM D
• Bridget D Piernas, BEHAVIOR TECHNITIAN
• Pinnacle Hospice, LLC
• Latoya Carson Plummer, PT, DPT

• Dentist in Diberville, MS
• Providers in Diberville, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; 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.