Active NPI
Donna Lynn Peterson, DDS
- General Practice Dentistry
- Stockton, CA
National Provider Identifier
1942506233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- CA34189
- Practice address
- 9409 Thornton Rd
Stockton, CA 95209 - Phone
- (209) 473-2521
- Fax
- (209) 473-4437
- NPI assigned
- Feb 3, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | CA34189 | CA | Primary |
Addresses
Primary practice location
9409 Thornton Rd
Stockton, CA 95209
Mailing address
9409 Thornton Rd
Stockton, CA 95209
Phone (209) 473-2521
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B34189-01 | Other | CA | MEDICAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA34189 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296691200000",
"number": "1942506233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9409 THORNTON RD",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95209",
"telephone_number": "209-473-2521",
"fax_number": "209-473-4437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9409 THORNTON RD",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95209",
"telephone_number": "209-473-2521",
"fax_number": "209-473-4437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DONNA",
"middle_name": "LYNN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-03",
"last_updated": "2011-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "CA34189",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "B34189-01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.