Brandon Keith Peterson, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DDS-08288 Issued in IA

Practice address

6600 Westown Pkwy
Suite 170
West Des Moines, IA 50266-7707

Phone

(515) 223-9700

NPI assigned

Jan 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431216000000",
    "number": "1700864543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 WESTOWN PKWY",
            "address_2": "SUITE 170",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502667707",
            "telephone_number": "515-223-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 WESTOWN PKWY",
            "address_2": "SUITE 170",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502667707",
            "telephone_number": "515-223-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BRANDON",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2015-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027419",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IA",
            "license": "DDS-08288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy K. Petersen, D.O.
• Baylee Petersen
• Danielle Elaine Petersen
• Theresa Diane Petersen, RPH
• Ashley Wilke Peterson, APRN
• Caitlyn Peterson
• Chelsea Peterson, T-LMHC
• Danielle Jo Peterson
• Emily J Peterson, PA-C
• Ginni Marie Peterson, PT

• Periodontics in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Periodontics in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2015; 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.