DR. SAMUEL PETERSEN, DMD
Dentist - General Practice
Active
Individual
NPI: 1720571284
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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