DR. KIRK JOHN PETERSEN D.M.D.
NPI 1285638106
Dentist in Smith River, CA

Q: What is Kirk Petersen's NPI number?

The NPI number for Kirk Petersen is 1285638106. It was assigned to this individual provider in the NPPES registry on June 9, 2005.

Q: What is Kirk Petersen's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Kirk Petersen was last updated on March 3, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 09, 2005PECOS Enrolled

501 N INDIAN RD, SMITH RIVER, CA 95567(707) 487-0215 Get Directions Write a Review

NPPES record last updated: March 3, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Dr. Kirk John Petersen D.m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KIRK JOHN PETERSEN D.M.D. (NPI 1285638106) is an individual dentist in Smith River, California, licensed in California (35534) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1285638106

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameDR. KIRK JOHN PETERSENCredential: D.M.D.

Location Address501 N INDIAN RDSmith River, CA 95567-9509

Mailing Address1301 S Pebble Beach DrCrescent City, CA 95531-3339 · (951) 265-2240

Phone(707) 487-0215

Sole ProprietorNo

Enumeration DateJune 9, 2005

Last NPPES UpdateMarch 3, 2018

✔ NPI 1285638106 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in CA · 35534

Definition

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.

501 N INDIAN RD, Smith River, CA 95567

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kirk John Petersen D.m.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95567 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.32 typical visit price

range $58.87 – $176.60

Typical copayment $22.58 (range $14.71 – $44.15)

Most-billed visit code 99203

Established Patient

$73.16 typical visit price

range $19.28 – $144.60

Typical copayment $18.29 (range $4.82 – $36.15)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VINCENT TRAN DDS

Dentist (General Practice)