DAVID PETERSON (NPI# 1215410584) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215410584 |
| Entity Type | Individual |
| Full Name | DAVID PETERSON |
| Credential | DDS |
| Practice Address |
1619 Brandywine Ln Dixon IL 61021-8757 |
| Practice Telephone | 8156224740 |
| Mailing Telephone | 8156224740 |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2018-09-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
021001236 | IL | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | LICENSE | 019017734 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386070647 | David Michael Peterson | Pharmacist | 1200 W Gold St, Butte, MT 59701-2110 | 2013-09-18 |
| 1427336601 | David James Peterson | Physical Therapist | 59 Akea Pl, Kula, HI 96790-8501 | 2011-07-22 |
| 1386858942 | David Brian Peterson | Psychologist | 460 Oak St, Apt 115, Glendale, CA 91204-1265 | 2007-05-10 |
| 1851412241 | David Peterson | Chiropractor | 17331 Penn Valley Dr, Penn Valley, CA 95946-9340 | 2007-04-03 |
| 1487716783 | David Norman Peterson | Dentist | 22 2nd Ave S, Sauk Rapids, MN 56379-1408 | 2006-12-14 |
| 1033279484 | David Eugene Peterson | Dentist | 17267 W 3rd St, Sddc, Redfield, SD 57469-1001 | 2006-12-08 |
| 1801968359 | David Scott Peterson | Psychiatry & Neurology | 1345 East 3900 South Ste 208, Salt Lake City, UT 84124-4416 | 2006-11-13 |
| 1104905272 | David Hedden Peterson | Social Worker | 222 9th Ave W, Alexandria, MN 56308-2221 | 2006-11-02 |
| 1932284031 | David Donald Peterson | Counselor | 318 E Main St # 106, Battle Ground, WA 98604-8508 | 2006-10-26 |
| 1841398336 | David Donald Peterson | Chiropractor | 2516 7th Ave E, Saint Paul, MN 55109-3003 | 2006-09-20 |
| Street Address |
1619 BRANDYWINE LN |
| City | DIXON |
| State | IL |
| Zip Code | 61021-8757 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699331082 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1600 South Galena Ave, Dixon, IL 61021 | 2019-05-12 |
| 1285135590 | Richard Allen Sibert | Counselor | 325 Il Route 2,dixon Il, Dixon, IL 61021 | 2018-02-22 |
| 1518485432 | Madeline Luniewicz | Counselor | 325 Il-2, Dixon, IL 61021 | 2017-08-30 |
| 1669992566 | Nicole Marie Shaffer | Specialist/Technologist | 650 Reynoldswood Road, Dixon, IL 61021 | 2017-06-21 |
| 1346660446 | Lydia Sitter | Audiologist | 215 3. 1st Street, Suite 317, Ksb Medical Group, Dixon, IL 61021 | 2014-04-16 |
| 1053600080 | Janet I. Malmberg | Nurse Practitioner | 309 South Galena Ave, Suite 100, Dixon, IL 61021 | 2011-03-30 |
| 1376775262 | Kelly L Klein | Optometrist | 511 Palmyra Street, Ksb Eye & Vision Care, Dixon, IL 61021 | 2009-08-11 |
| 1013119106 | Michael Joseph Sarno | Physical Therapist | 401 E. First Street, Dixon, IL 61021 | 2007-06-01 |
| 1891905600 | Thomas G. Gehlbach | Internal Medicine | 215 E 1st St Ste 111, Dixon, IL 61021 | 2007-05-23 |
| 1699987230 | Sameer Jain | Family Medicine | 102 S. Hennepin Ave., Ksb Medical Group, Dixon, IL 61021 | 2007-05-04 |
| Find all providers in zip 61021 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255986576 | Othman Rezki | Dentist | 1900 W Polk St # 611, Chicago, IL 60612-3723 | 2019-08-04 |
| 1952887374 | Winnebago Braces, LLC. | Dentist | 555 N Court St Ste 110, Rockford, IL 61103-6898 | 2018-07-18 |
| 1093232951 | Robert C. Bosack, Dds & Associates, Ltd | Dentist | 16011 108th Ave Ste A, Orland Park, IL 60467-8787 | 2017-08-23 |
| 1790146132 | Family Millennium Dentistry, Inc. | Dentist | 1342 W Randolph St, Chicago, IL 60607-1522 | 2016-03-13 |
| 1770962375 | Eunsu Jung | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2015-05-28 |
| 1811374945 | Alexandria Hawkins | Dentist | 6050 Brynwood Dr Ste 102, Rockford, IL 61114-6579 | 2015-04-27 |
| 1043607872 | Alissa Nicole Pullos | Dentist | 105 E 1st St Ste 103, Hinsdale, IL 60521 | 2015-04-20 |
| 1538592654 | Matthew Seena Hamedani | Dentist | 3116 Oak Park Ave, Berwyn, IL 60402 | 2013-08-13 |
| 1578907689 | M Timothy Murphy | Dentist | 500 Davis St Ste 509, Evanston, IL 60201-4621 | 2013-04-18 |
| 1104260314 | Cameron James Walker | Dentist | 2160 S 1st Ave Rm 1814, Maywood, IL 60153-3328 | 2013-04-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.