Robert Kenneth Peterson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-017071 Issued in IL

Practice address

2932 Finley Rd
Downers Grove, IL 60515-1042

Phone

(630) 629-6299

NPI assigned

May 16, 2007

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

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.

• Geneva Family Dentistry, P.C.

  • Clinic/Center
  • Downers Grove, IL
  • NPI 1609382902
  NPD (past) Authorized official
• Main Street Square Dental, LLC

  • General Practice Dentistry
  • Downers Grove, IL
  • NPI 1720623325
  NPD (past) Authorized official
• Willow Ridge Dental Group LLC

  • General Practice Dentistry
  • Naperville, IL
  • NPI 1215206842
  NPD (past)

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1801003314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1644 BARKEI DR",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605108304",
            "telephone_number": "847-624-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2932 FINLEY RD",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151042",
            "telephone_number": "630-629-6299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 Brom Ct",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Naperville",
            "state": "IL",
            "postal_code": "605406531",
            "country_code": "US",
            "telephone_number": "630-420-2800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "112 N 4th St",
            "address_purpose": "LOCATION",
            "city": "Geneva",
            "state": "IL",
            "postal_code": "601342125",
            "country_code": "US",
            "telephone_number": "847-624-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ROBERT",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-017071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Personal Path
• Nimisha Perumpel
• Jana Peters, MS
• Eileen M. Peterson, LCSW
• Elizabeth Helen Peterson, MS, OTR/L
• Walter Petri, M.D.
• Marissa N Pezzulo, LCSW
• Carrie Phillips
• Jennifer Phillips, RSA
• Valerie Phillips, MD

• General Practice Dentistry in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; 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.