NPIMap

Organization Active NPI

Peter C. Nelson DDS, Inc.

  • General Practice Dentistry
  • San Luis Obispo, CA
National Provider Identifier
1770775975
Registry record updated Sep 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
21276 Issued in CA
Legal business name
PETER C. NELSON DDS, INC.
Practice address
1250 Peach St Ste L
San Luis Obispo, CA 93401-2875
Phone
(805) 544-1877
Fax
(805) 544-9026
NPI assigned
Aug 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2007

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

Authorized official

Name
Dr. Peter C. Nelson, D.D.S.NPI 1952475972
Title
Owner
Phone
(805) 544-1877

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 21276 CA Primary

Addresses

Primary practice location

1250 Peach St Ste L
San Luis Obispo, CA 93401-2875

Mailing address

1250 Peach St Ste L
San Luis Obispo, CA 93401-2875
Phone (805) 544-1877

Other identifiers 1

IdentifierTypeStateIssuer
B21276OtherCAMEDICAL

National Provider Directory

National Provider Directory

Locations

1250 Peach St
Ste L
San Luis Obispo, CA 93401
Phone (805) 544-1877

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1770775975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 PEACH ST STE L",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012875",
            "telephone_number": "805-544-1877",
            "fax_number": "805-544-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 PEACH ST STE L",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012875",
            "telephone_number": "805-544-1877",
            "fax_number": "805-544-9026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER C. NELSON DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-544-1877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "21276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "B21276",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.

Verify at the official NPI Registry.