Nicholas Dee Petersen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14223904-9926 Issued in UT

Practice address

1234 N 900 E Ste 100
Provo, UT 84604-2726

Phone

(801) 854-9140

NPI assigned

May 23, 2025

Last updated

May 23, 2025By the provider in NPPES

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

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ninth East Dental

  • General Practice Dentistry
  • Provo, UT
  • NPI 1902470198
  NPD

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

{
    "created_epoch": "1747958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1912790965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1573 W MORNING VIEW WAY",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840437733",
            "telephone_number": "503-475-5812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 N 900 E STE 100",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846042726",
            "telephone_number": "801-854-9140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "NICHOLAS",
        "middle_name": "DEE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-05-23",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "14223904-9926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanner Gardner Perry, DMD
• Stephen Peters, PSYD
• Dantzel Lily Petersen-Hancey
• Andrew D Petersen, DO
• Danielle Karin Petersen
• Riley Wayne Petersen, PMHNP
• Rodney C Petersen, MD
• Tiffani Petersen, NP
• Aaron Stephen Peterson, PA-C
• Anne Peterson

• General Practice Dentistry in Provo, UT
• Providers in Provo, 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 May 23, 2025; 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.