Peter Jay Paulson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10402 Issued in MN

Practice address

5001 Winnetka Ave N
New Hope, MN 55428-4230

Phone

(763) 533-0055

NPI assigned

Jan 10, 2007

Last updated

Jul 29, 2011By the provider in NPPES

Sex

Male

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 MN

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family & Cosmetic Gentle Dentistry, LTD

  • General Practice Dentistry
  • New Hope, MN
  • NPI 1275715732
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311897600000",
    "number": "1699824276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 131947",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551130022",
            "telephone_number": "651-357-8647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 WINNETKA AVE N",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554284230",
            "telephone_number": "763-533-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "PETER",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2011-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mitchell C Olson, DC
• Open Mind Center LLC
• Bryan Jeffrey Ophaug, D.D.S.
• Own Self Be True, LLC (Be True)
• Papacare, Inc.
• Jacob Paust
• Michelle Pelzel
• Emily Penrod, MSCCCSLP
• People Incorporated
• Katie Suzanne Perzel, LICSW

• General Practice Dentistry in New Hope, MN
• Providers in New Hope, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.