TAYNE PETERSON

Dentist - General Practice

Active Individual
NPI: 1952960205

Practice Address

2200 PARK AVE STE 2
Burley, ID 83318

Phone: (208) 878-6684

Specialties

Specialty Code Primary License
Dentist - General Practice 1223G0001X Yes D-5401 (ID)

Frequently Asked Questions

NPI 1952960205 is the National Provider Identifier for TAYNE PETERSON, a Dentist - General Practice provider located in Burley, ID. This NPI was enumerated on June 11, 2019.
TAYNE PETERSON practices at 2200 PARK AVE STE 2, Burley, ID 83318.

Quick Facts

NPI
1952960205
Type
Individual
Enumerated
Jun 11, 2019
Last Updated
Sep 7, 2022

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