Active NPI
Peter B. Nelson, DMD, PC
- Pediatric Dentistry
- Kalispell, MT
National Provider Identifier
1689720161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- MT1397
- Practice address
- 795 Sunset Blvd
Kalispell, MT 59901-3699 - Phone
- (406) 752-8302
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | MT1397 | MT | Primary |
Addresses
Primary practice location
795 Sunset Blvd
Kalispell, MT 59901-3699
Mailing address
795 Sunset Blvd
Kalispell, MT 59901-3699
Phone (406) 752-8302
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 011-2554 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT1397 | MT | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689720161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "795 SUNSET BLVD",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599013699",
"telephone_number": "406-752-8302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "795 SUNSET BLVD",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599013699",
"telephone_number": "406-752-8302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "PETER",
"middle_name": "B.",
"credential": "DMD, PC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MT",
"license": "MT1397",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "011-2554",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalispell, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.