Marie Ann Peterson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1811480239 Issued in UT

Practice address

8915 S 700 E Ste 103
Sandy, UT 84070-2421

Phone

(015) 622-1478

NPI assigned

Jun 11, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1811480239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8915 S 700 E STE 103",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840702421",
            "telephone_number": "801-581-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8915 S 700 E STE 103",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840702421",
            "telephone_number": "015-622-1478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARIE",
        "middle_name": "ANN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "1811480239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mathew Petersen, ABOC
• Clifton Kent Peterson, L.C.S.W.
• Holly Sue Peterson, LCSW
• James Wesley Peterson, PHARMD
• Madeline Peterson, RDN
• Ryan Peterson, CMHC
• Patrick Pfau, D.O.
• Kelly Jo Phillips, APRN
• Richard V Phillips
• Angelina Pierce, N.P.

• General Practice Dentistry in Sandy, UT
• Providers in Sandy, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; 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.