Active NPI
Kevin L Peterson, DMD
- Endodontics
- Brookline, MA
National Provider Identifier
1699789115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 19670
- Practice address
- 1 Brookline PL
Suite 505
Brookline, MA 02445-7224 - Phone
- (617) 735-8500
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 19670 | MA | Primary |
Addresses
Primary practice location
1 Brookline PL
Suite 505
Brookline, MA 02445-7224
Mailing address
220 Boylston St
Apt. 9018
Boston, MA 02116-3929
Phone (617) 216-8042
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 |
|---|---|---|---|
| 19670 | MA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699789115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 BOYLSTON ST",
"address_2": "APT. 9018",
"city": "BOSTON",
"state": "MA",
"postal_code": "021163929",
"telephone_number": "617-216-8042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BROOKLINE PL",
"address_2": "SUITE 505",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024457224",
"telephone_number": "617-735-8500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KEVIN",
"middle_name": "L",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MA",
"license": "19670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
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.