Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. SAMUEL PETERSEN, DMD
Active Sole ProprietorDR. SAMUEL PETERSEN, DMD is a General Dentistry healthcare provider located in EAGLE, Idaho. NPI 1720571284 is currently active in the NPPES registry. Verify at CMS.
General Dentistry · EAGLE, ID
Registration Details
- NPI Number
- 1720571284
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 10, 2018 (8.1350679309519 yrs)
- Last Updated
- Feb 28, 2024
- Licenses
-
10136 (KY)D-5038 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
450 W STATE ST STE 115EAGLE, ID, 836167055Browse ID providers · Browse ZIP 83616
- Phone
- 2083705203
- Fax
- 2083705204
- Primary Specialty
-
General Dentistry
1223G0001X
- Additional Specialty
- General Dentistry
Other General Dentistry Providers in EAGLE, ID
| Name | Credential | NPI |
|---|---|---|
| DR. ANDREW DALE BAIRD | DDS, PLLC | 1760595144 |
| DR. RYAN N VAN ALFEN | DDS, PLC | 1245343631 |
| GILBERT H SIMPSON | D.M.D. | 1912072364 |
| DR. JOEL EDWARD COURTIAL | DDS | 1124193123 |
| DR. MICHAEL JOHN SEYLER | D.D.S. | 1861549826 |
| GEORGE D. CHEN | DDS | 1154449163 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.