Haley Petersen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS110940 Issued in CA

Practice address

3081 Teagarden St
San Leandro, CA 94577-5720

Phone

(510) 347-4620

NPI assigned

Dec 4, 2024

Sex

Female

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• The Davis Street Community Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • San Leandro, CA
  • NPI 1215358924
  Medicare reassignment

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1689480782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 VISTA CT",
            "city": "BENICIA",
            "state": "CA",
            "postal_code": "945102716",
            "telephone_number": "707-334-4221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3081 TEAGARDEN ST",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945775720",
            "telephone_number": "510-347-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "HALEY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS110940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clara Jean Perry, LVN
• Ellen Elizabeth Perry
• Perspectives Counseling & Consultation Inc.
• Ariana Tavano Peters
• Emily Peters
• Erin Peterson, MFT
• Kelly Peterson
• Michael Blair Peterson, M.D.
• Benjamin Allan Petrofsky
• Michael Petruolo, ASW

• General Practice Dentistry in San Leandro, CA
• Providers in San Leandro, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.