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Deactivated NPI 1457422602 Deactivated / Inactive NPI Female Practitioner

Dr. Mardelle Petersen , DDS

Dentist - General Practice • Reno, NV

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Mardelle Petersen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 10, 2006
NPI Deactivation Date August 24, 2021
Total Practice Duration ~15 Years of Practice (2006 – 2021)

Professional Overview & Biography Verified Profile Summary

Dr. Mardelle Petersen, DDS was a registered Dentist - General Practice practicing in Reno, NV. Throughout an active medical career spanning 15 years, Dr. Petersen provided care at the practice location at 952 YORI AVE until profile deactivation on 2021-08-24.

Practice Location & Contact Primary Location

Practice Address

952 Yori Ave

Reno, NV 895022643

Telephone 7758300395

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Reno, NV

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 27.0 Yrs
State Avg: 22.0 Yrs
Regional Practice Density
148 Specialists

Practicing in Reno, NV (1127 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License AZ 3591

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.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated August 24, 2021

Record deactivated on August 24, 2021

NPI Profile Active August 31, 2010

NPI status registered as active in NPPES database

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Updated Practice Location August 31, 2010

Registered at 952 YORI AVE, RENO, NV 895022643 (Tel: 7758300395)

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Updated Business Mailing Address August 31, 2010

Registered at 952 YORI AVE, RENO, NV 895022643 (Tel: 7758300395)

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Provider Name / Credentials Updated August 31, 2010

Recorded as MARDELLE PETERSEN, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 31, 2010

Dentist (License #3591 in AZ)

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Initial NPI Registration & Enumeration November 10, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1457422602
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 10, 2006
Last Update: August 31, 2010
Deactivation Date: August 24, 2021

Mailing Address

952 Yori Ave

Reno, NV 895022643

Phone: 7758300395

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.