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Deactivated NPI 1003966169 Deactivated / Inactive NPI Male Practitioner

Dr. Elden Walter Peterson , DDS

Dentist • West Jordan, UT

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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. Elden Peterson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date January 11, 2007
NPI Deactivation Date September 25, 2025
Total Practice Duration ~18 Years of Practice (2007 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Elden Peterson, DDS was a registered Dentist practicing in West Jordan, UT. Throughout an active medical career spanning 18 years, Dr. Peterson provided care at the practice location at 9269 REDWOOD RD until profile deactivation on 2025-09-25.

Practice Location & Contact Primary Location

Practice Address

9269 Redwood Rd

West Jordan, UT 840886572

Telephone 8015664153
Fax 8015661963

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in West Jordan, UT

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 6.0 Yrs
Regional Practice Density
26 Specialists

Practicing in West Jordan, UT (758 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 Primary Specialty

NUCC Taxonomy Code: 122300000X

State License UT 1307709922

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
NPI 1295879989

Doctor of Dental Surgery

NPI 1316561244

Doctor of Dental Medicine

NPI 1386864460

Doctor of Dental Surgery

NPI 1881255727

Doctor of Dental Medicine

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 September 25, 2025

Record deactivated on September 25, 2025

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 9269 REDWOOD RD, WEST JORDAN, UT 840886572 (Tel: 8015664153)

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Updated Business Mailing Address July 08, 2007

Registered at 9269 REDWOOD RD, WEST JORDAN, UT 840886572 (Tel: 8015664153)

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Provider Name / Credentials Updated July 08, 2007

Recorded as ELDEN PETERSON, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #1307709922 in UT)

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Initial NPI Registration & Enumeration January 11, 2007

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: 1003966169
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 11, 2007
Last Update: July 08, 2007
Deactivation Date: September 25, 2025

Mailing Address

9269 Redwood Rd

West Jordan, UT 840886572

Phone: 8015664153

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.