DR. MARK EDWARD PETERSON (NPI# 1528013661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528013661 |
| Entity Type | Individual |
| Full Name | DR. MARK EDWARD PETERSON |
| Credential | DDS |
| Practice Address |
2440 Gaynor Nw Grand Rapids MI 49544-1830 |
| Practice Telephone | 6167848444 |
| Practice Fax Number | 6167846912 |
| Mailing Telephone | 6167848444 |
| Mailing Fax Number | 6167846912 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2019-03-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 13556 | MI | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 124241245 | 05 | |
| BLUE CROSS ID | D135560 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164069696 | Mark Alan Peterson | In Home Supportive Care | 5870 Nw 54th Ct, Johnston, IA 50131-1418 | 2019-12-03 |
| 1841474012 | Mark Frederic Peterson I | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3351 36th St, Grand Rapids, MI 49331 | 2007-12-24 |
| 1780877258 | Mark A. Peterson | Counselor | 7322 Scenic Oaks Cir, Austin, TX 78745-5217 | 2007-08-19 |
| 1871702076 | Mark Clayton Peterson | Dentist | 1600 W Sunset Rd Ste B, Henderson, NV 89014-2655 | 2007-05-22 |
| 1558481366 | Mark Theodore Peterson | Specialist | 5712 Newburg Rd, Rockford, IL 61108-6707 | 2007-03-29 |
| 1073608170 | Mark A Peterson | Dentist | 7740 Bay St, Suite # 1, Sebastian, FL 32958-3427 | 2006-10-04 |
| 1689782864 | Mark L Peterson | Dentist | 127 1/2 E Short St, Rigby, ID 83442-1422 | 2006-08-28 |
| 1699763607 | Mark Delano Peterson | Orthopaedic Surgery | 1311 E Barnett Rd, Ste 201, Medford, OR 97504-8225 | 2005-10-12 |
| 1477551836 | Mark Dean Peterson | Chiropractor | 5406 Alderson St, Schofield, WI 54476-2264 | 2005-07-11 |
| 1477043842 | Mark Peterson | Student in an Organized Health Care Education/Training Program | 1115 20th St Ste 205, Huntington, WV 25703-2071 | 2018-05-11 |
| Street Address |
2440 GAYNOR NW |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49544-1830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764511 | Titiana Shanee Richardson | Social Worker | 113 Lake Michigan Drive Northwest, Grand Rapids, MI 49544 | 2020-09-15 |
| 1699317792 | Leah Grace Nesburg | Speech-Language Pathologist | 600 3 Mile Road Nw, Suite 102, Walker, MI 49544 | 2019-10-10 |
| 1316467954 | Hendrik Vanholsbeeck | Dentist | 2515 Alpine Ave Nw # A, Grand Rapids, MI 49544 | 2017-06-25 |
| 1467988584 | Leah Feenstra | Behavior Technician | 668 3 Mile Nw, Grand Rapids, MI 49544 | 2017-05-10 |
| 1760920698 | Heidi Catherine Stultz-griffey | Pharmacist | 970 4 Mile Rd Nw Apt 1d, Grand Rapids, MI 49544 | 2017-02-12 |
| 1336591791 | Nicole Totten | Dentist | 3320 Alpine Ave., Grand Rapids, MI 49544 | 2016-07-11 |
| 1255789145 | Lucas David Kelley | Technician, Other | 668 3 Mile Ave Nw, Suite 2, Grand Rapids, MI 49544 | 2016-06-01 |
| 1144611666 | Stephen Kornoely | Social Worker | 2118 3 Mile Road Nw, Grand Rapids, MI 49544 | 2015-02-06 |
| 1023368305 | Brian William Rogers | Registered Nurse | 712 North Center Dr. Nw, Grand Rapids, MI 49544 | 2012-09-14 |
| 1477885325 | Wilson and Wynn Interventions | Community/Behavioral Health | 680 Three Mile Nw, Suite 150, Grand Rapids, MI 49544 | 2010-02-03 |
| Find all providers in zip 49544 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639797640 | Kadie Ann Koolwick | Dentist | 5500 Northland Dr Ne, Grand Rapids, MI 49525-1064 | 2020-07-07 |
| 1962053744 | Gr Sound Sleep LLC | Dentist | 6677 Crossings Dr Se Ste 4, Grand Rapids, MI 49508-7889 | 2019-09-24 |
| 1598323016 | Kelly Reinhardt | Dentist | 847 Parchment Dr Se Ste 110, Grand Rapids, MI 49546-2377 | 2019-05-30 |
| 1063079242 | Andrew Stuart Kuehn | Dentist | 1121 Se 4th Ave, Grand Rapids, MN 55744-3956 | 2019-05-23 |
| 1316467954 | Hendrik Vanholsbeeck | Dentist | 2515 Alpine Ave Nw # A, Grand Rapids, MI 49544 | 2017-06-25 |
| 1710417969 | Mccoy Family Dentistry | Dentist | 2330 44th St Se, Grand Rapids, MI 49508-4700 | 2017-06-19 |
| 1427594027 | Mel Trotter Ministries Dental Clinic | Dentist | 225 Commerce Ave Sw, Grand Rapids, MI 49503-4107 | 2017-01-06 |
| 1265980957 | Brittany Ann Rashid | Dentist | 2549 Tall Timber Ct Se, Grand Rapids, MI 49546-6787 | 2016-09-12 |
| 1336591791 | Nicole Totten | Dentist | 3320 Alpine Ave., Grand Rapids, MI 49544 | 2016-07-11 |
| 1083098198 | Alexandra Dodds | Dentist | 2609 Breton Rd Se, Grand Rapids, MI 49546 | 2015-07-17 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49544 |
Please comment or provide details below to improve the information on DR. MARK EDWARD PETERSON.
| 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.