Katherine R. Petersen, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

10553 Issued in NC

Practice address

10230 Berkeley Place Dr Ste 200
Charlotte, NC 28262-1203

Phone

(704) 688-7588

NPI assigned

Aug 6, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Katherine E. Rhyne Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 6, 2016 through Jan 6, 2028

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 and National Provider Directory roles.

• Stella O Nnadi DMD PA

  • Dental Clinic/Center
  • Charlotte, NC
  • NPI 1386358315
  NPD
• Charlotte Sleep Solutions Corporation

  • Customized Equipment (DME)
  • Charlotte, NC
  • NPI 1801361878

  Dentist

  NPD (past)
• Thad Pierce Johnston DDS PA

  • General Practice Dentistry
  • Gastonia, NC
  • NPI 1588590855
  NPD (past)
• Dental Professionals of Virginia, P.C.

  • General Practice Dentistry
  • Williamsburg, VA
  • NPI 1497351803
  NPD (past)
• Williamsburg Center for Dental Health

  • Dentist
  • Williamsburg, VA
  • NPI 1053856468
  NPD (past)

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1992996946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 CREEK SIDE DR",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281209247",
            "telephone_number": "704-577-2798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10230 BERKELEY PLACE DR STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282621203",
            "telephone_number": "704-688-7588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KATHERINE",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2021-03-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "10553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "RHYNE",
            "middle_name": "E.",
            "prefix": "DR.",
            "credential": "D.M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Thomas Peters, MD
• Joanna Barrett Peters, PSYD
• Marco Antonio Peters, D.C.
• Sensemillah Zakiya Peters, CLINSCD CCC-SLP
• Stewart Todd Peters, D.C.
• Elizabeth Ann Peterson-Vita, PHD
• Benjamin Peterson
• Brad Michael Peterson
• Carolyn N. Peterson, RDN, LDN
• Catherine Cant Peterson, PHD

• Dentist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.