Tara Skelly Peterson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D13973 Issued in MN

Practice address

9042 Cahill Ave
Inver Grove Heights, MN 55076-3543

Phone

(651) 457-8282

NPI assigned

May 14, 2018

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 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

State licenses

Practice roles

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.

• Northland Dental Partners, PLLC

  • General Practice Dentistry
  • Inver Grove Heights, MN
  • NPI 1366190738
  NPD (past)

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1700376969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4663 PARKRIDGE DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232130",
            "telephone_number": "651-587-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9042 CAHILL AVE",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550763543",
            "telephone_number": "651-457-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TARA",
        "middle_name": "SKELLY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-14",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Penny Lane Homes
• Carrie Buerman Peroutka, DDS
• Personalized Care for All LLC
• Chelsey Marie Peters
• Erik James Peterson, D.C.
• PHS/Inver Grove, Inc.
• Daniel Mathew Pietruszewski
• Jesse C. Ploessl, D.C.
• Sonia Felicia Pollock, DPT
• Patricia Gayle Polski, MA, LGSW

• Dentist in Inver Grove Heights, MN
• Providers in Inver Grove Heights, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2018; 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.