DR. GORDON CHARLES PETERSON D.D.S. NPI 1902073174

NPI Information

NPI: 1902073174
Provider Name: DR. GORDON CHARLES PETERSON, D.D.S.
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

Address:
2701 1ST AVE SE
CEDAR RAPIDS, IA
ZIP 52402
Phone: (319) 364-5561
Get Directions

DR. Gordon Charles Peterson, D.D.S. is a general practice dentist in Cedar Rapids, IA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Gordon Charles Peterson, D.D.S. NPI is 1902073174. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2701 1ST AVE SE
CEDAR RAPIDS, IA
ZIP 52402-834
Phone: (319) 364-5561
Fax: (319) 364-1717

The enumeration date for this NPI number is 5/15/2008 and was last updated on 5/15/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	6573	IOWA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0500744	MEDICAID	IOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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