Peter Victor Vanstrom, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

010656 Issued in GA

Practice address

2012 Harobi Drive
Suite a
Tucker, GA 30084-5161

Phone

(404) 325-2905

NPI assigned

Oct 13, 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

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.

• Peter V. Vanstrom, DDS, PC

  • Dentist
  • Atlanta, GA
  • NPI 1184031239
  NPD (past) Authorized official

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1831289677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2296 HENDERSON MILL RD NE STE 108",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452739",
            "telephone_number": "404-325-2905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 HAROBI DRIVE",
            "address_2": "SUITE A",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845161",
            "telephone_number": "404-325-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANSTROM",
        "first_name": "PETER",
        "middle_name": "VICTOR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "010656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Tucker, GA
• Providers in Tucker, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.