NPIMap

Organization Active NPI

Venn R. Peterson, D.D.S., Inc.

  • Dentist
  • Lacey, WA
National Provider Identifier
1962695015
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8985 Issued in WA
Legal business name
VENN R. PETERSON, D.D.S., INC.
Practice address
5024 Lacey Blvd SE
Lacey, WA 98503-5729
Phone
(360) 459-4420
Fax
(360) 459-4425
NPI assigned
Aug 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

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

Authorized official

Name
Venn R Peterson, D.D.S.
Title
Dentist
Phone
(360) 459-4420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 8985 WA Primary

Addresses

Primary practice location

5024 Lacey Blvd SE
Lacey, WA 98503-5729

Mailing address

5024 Lacey Blvd SE
Lacey, WA 98503-5729
Phone (360) 459-4420

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1962695015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5024 LACEY BLVD SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035729",
            "telephone_number": "360-459-4420",
            "fax_number": "360-459-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5024 LACEY BLVD SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035729",
            "telephone_number": "360-459-4420",
            "fax_number": "360-459-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENN R. PETERSON, D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "VENN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "360-459-4420",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "8985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; 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.