DR. SAMUEL PETERSEN, DMD

Dentist - General Practice

Active Individual
NPI: 1720571284

Practice Address

450 W STATE ST STE 115
Eagle, ID 83616

Phone: (208) 370-5203

Specialties

Specialty Code Primary License
Dentist 122300000X No 10136 (KY)
Dentist - General Practice 1223G0001X Yes D-5038 (ID)

Frequently Asked Questions

NPI 1720571284 is the National Provider Identifier for DR. SAMUEL PETERSEN, DMD, a Dentist - General Practice provider located in Eagle, ID. This NPI was enumerated on June 10, 2018.
DR. SAMUEL PETERSEN, DMD practices at 450 W STATE ST STE 115, Eagle, ID 83616.

Quick Facts

NPI
1720571284
Type
Individual
Enumerated
Jun 10, 2018
Last Updated
Feb 28, 2024

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