1. Home
  2. Directory
  3. Michigan
  4. Grand Rapids
  5. Dentist
  6. NPI Profile

MARK E PETERSON, DDS
NPI 1639638265
Dentist - General Practice in Grand Rapids, MI

Active since March 13, 2019
2440 GAYNOR AVE NW, GRAND RAPIDS, MI 49544(616) 784-8444(616) 784-6912 Get Directions Write a Review

NPPES record last updated: March 14, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mark E Peterson, Dds NPPES

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

MARK E PETERSON, DDS (NPI 1639638265) is a healthcare organization registered as a general practice in Grand Rapids, Michigan and active in the NPI registry since March 2019. The organization lists Mark Peterson, Dentist, as its authorized official.

NPPES Registry Identity

NPI1639638265
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameMARK E PETERSON, DDS
Location Address2440 GAYNOR AVE NWGrand Rapids, MI 49544-1830
Mailing Address2440 Gaynor Ave NwGrand Rapids, MI 49544-1830 · (616) 784-8444 · Fax (616) 784-6912
Phone(616) 784-8444
Fax(616) 784-6912
Organization SubpartNo
Authorized OfficialMark PetersonDentist · (616) 784-8444
Enumeration DateMarch 13, 2019
Last NPPES UpdateMarch 14, 2019
✔ NPI 1639638265 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
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.
2440 GAYNOR AVE NW, Grand Rapids, MI 49544
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

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

LEGACY DENTAL ASSOCIATES
Dentist (General Practice)
2440 GAYNOR AVE NW
GRAND RAPIDS, MI 49544
Kent County (616) 784-8444

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark E Peterson, Dds's NPI number?

The NPI number for Mark E Peterson, Dds is 1639638265. It was assigned to this organization in the NPPES registry on March 13, 2019.

Where is Mark E Peterson, Dds located?

Mark E Peterson, Dds is located at 2440 Gaynor Ave NW, Grand Rapids, MI 49544. The listed phone number is (616) 784-8444.

What is Mark E Peterson, Dds's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Mark E Peterson, Dds was last updated on March 14, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.