Benjamin Robert Peterson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

08702 Issued in IA

Practice address

424 South St.
Waterloo, IA 50701

Phone

(319) 234-2684

Fax

(319) 233-5974

NPI assigned

Jul 29, 2008

Last updated

Oct 4, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• William C. Bolick D.DS L.L.C.

  • General Practice Dentistry
  • Waterloo, IA
  • NPI 1659672038
  NPD (past)

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

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286150400000",
    "number": "1801052915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 SOUTH ST.",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "50701",
            "telephone_number": "319-234-2684",
            "fax_number": "319-233-5974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 SOUTH ST.",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "50701",
            "telephone_number": "319-234-2684",
            "fax_number": "319-233-5974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BENJAMIN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-29",
        "last_updated": "2010-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12600",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12600",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "08702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peoples Community Health Clinic, Inc. (Peoples Clinic Pharmacy)
• Michael F. Peters, M.D.
• James Robert Petersen, RPH
• Neal Petersen, TLMHC
• Adaline Lee Peterson, A.R.N.P.
• Jacob John Peterson, PHARMD
• Jaden Peterson
• Taylor Noelle Peterson, LMSW
• Jamie Petrie
• Thomas Paul Petrie, D.O.

• General Practice Dentistry in Waterloo, IA
• Providers in Waterloo, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; 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.