NPIMap

Organization Active NPI

Peterson Dental, LLC

  • Dentist
  • Leeds, AL
National Provider Identifier
1811366198
Registry record updated Sep 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5696 Issued in AL
Legal business name
PETERSON DENTAL, LLC
Practice address
1101 Higrove Pkwy
Suite 105
Leeds, AL 35094-1703
Phone
(205) 699-1155
Fax
(205) 699-1159
NPI assigned
Sep 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2015

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

Authorized official

Name
Nicole Peterson
Title
Cfo
Phone
(205) 699-1155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 5696 AL Primary

Addresses

Primary practice location

1101 Higrove Pkwy
Suite 105
Leeds, AL 35094-1703

Mailing address

1101 Higrove Pkwy
Suite 105
Leeds, AL 35094-1703
Phone (205) 699-1155

Other identifiers 3

IdentifierTypeStateIssuer
511-11930OtherALBCBS PROVIDER #
1102337492OtherCIGNA GEHA PROVIDER #
2586372OtherALUNITED CONCORDIA PROVIDER #

Other names 1

  • Peterson Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1101 Higrove Pkwy
Ste 105
Leeds, AL 35094
Phone (205) 699-1155

Practitioners & affiliated clinicians

Practitioners 2

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": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442448000000",
    "number": "1811366198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HIGROVE PKWY",
            "address_2": "SUITE 105",
            "city": "LEEDS",
            "state": "AL",
            "postal_code": "350941703",
            "telephone_number": "205-699-1155",
            "fax_number": "205-699-1159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HIGROVE PKWY",
            "address_2": "SUITE 105",
            "city": "LEEDS",
            "state": "AL",
            "postal_code": "350941703",
            "telephone_number": "205-699-1155",
            "fax_number": "205-699-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-17",
        "last_updated": "2015-09-17",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "205-699-1155"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "5696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "511-11930",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GEHA PROVIDER #",
            "identifier": "1102337492",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROVIDER #",
            "identifier": "2586372",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leeds, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; 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.