Benjamin T Peterson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8413 Issued in OR

Practice address

271 SW 13TH St
Ontario, OR 97914-4530

Phone

(541) 889-9407

Fax

(541) 889-6551

NPI assigned

Nov 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Rhett M. Tipton, DMD,PC

  • Dental Clinic/Center
  • Ontario, OR
  • NPI 1073207379
  NPD (past)

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1720159080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 SW 13TH ST",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979144530",
            "telephone_number": "541-889-9407",
            "fax_number": "541-889-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 SW 13TH ST",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979144530",
            "telephone_number": "541-889-9407",
            "fax_number": "541-889-6551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BENJAMIN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231468",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Pelayo, RMA
• Janette Lynn Pennington, CSWA
• Samantha Drey Perdue, QMHA
• Ashley Petersen
• Andrew Clair Peterson, M.D.
• Randolph E Peterson, MD
• Ashlee Nicole Petty
• Jeffrey F Phillips, MD
• John H Phillips, M.D.
• Physician'S Primary Care Center, Inc.

• General Practice Dentistry in Ontario, OR
• Providers in Ontario, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.