Thomas Merlin Peterson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8620 Issued in MN

Practice address

816 W St Germain St #101
St Cloud, MN 56301-3511

Phone

(320) 252-2454

Fax

(320) 252-2232

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Peterson Dental Associates, P.a.

  • General Practice Dentistry
  • St Cloud, MN
  • NPI 1396856100

  General Practice

  NPD (past)
• St. Cloud Family Dental PLLC

  • Dental Clinic/Center
  • Saint Cloud, MN
  • NPI 1699525915
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1891806709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 W ST GERMAIN ST #101",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563013511",
            "telephone_number": "320-252-2454",
            "fax_number": "320-252-2232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 W ST GERMAIN ST #101",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563013511",
            "telephone_number": "320-252-2454",
            "fax_number": "320-252-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "THOMAS",
        "middle_name": "MERLIN",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D8620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "838318900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaina Peterson, SLP
• Susan A Peterson, CRNA
• Tara Peterson
• Theodore A Peterson, M.D.
• Thomas M Peterson, PT
• George Petrangelo, LP
• Christine Petron
• Jodi Ann Petroski, PHARMD
• Richard Eldon Petzoldt, BS
• Yanqua Sumowuo Pewu, LPN

• All providers in St Cloud, MN
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; 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.