Joel Brandon Peterson, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

7272 Issued in IA

Practice address

3466 Holiday CT
Bettendorf, IA 52722-3496

Phone

(563) 332-1321

Fax

(563) 332-3905

NPI assigned

Oct 2, 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: joel.peterson.p2@direct.urologyqc.nextgenshare.com

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801989975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3466 HOLIDAY CT",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527223496",
            "telephone_number": "563-332-1321",
            "fax_number": "563-332-3905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3466 HOLIDAY CT",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527223496",
            "telephone_number": "563-332-1321",
            "fax_number": "563-332-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOEL",
        "middle_name": "BRANDON",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IA",
            "license": "7272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER #",
            "identifier": "29305",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROVIDER",
            "identifier": "637297",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "399655",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Babu Perumpail, M.D.
• Daniel Petefish, PHARMD
• Elizabeth Grace Peters, MA,CCC-SLP
• Joseph Conner Peters, OD
• Olivia Anna Peters, PA-C
• Robin R. Peterson, PSY.D
• Melissa Margaret Peyton, PA-C
• Phelps Consulting & Training, LLC
• Megan Phillips
• Physical Resolution Home Based Rehabilitation Services Inc

• Pediatric Dentistry in Bettendorf, IA
• Providers in Bettendorf, IA by specialty
• Pediatric Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.