Peterson Dental | |
127 1/2 E Short St Rigby ID 83442-1422 | |
(208) 745-6536 | |
(208) 745-0006 |
Full Name | Peterson Dental |
---|---|
Speciality | Dentist - General Practice |
Location | 127 1/2 E Short St, Rigby, Idaho |
Authorized Official Name and Position | Mark L Peterson (DENTIST) |
Authorized Official Contact | 2087456536 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Peterson Dental 127 1/2 E Short St Rigby ID 83442-1422 Ph: (208) 745-6536 | Peterson Dental 127 1/2 E Short St Rigby ID 83442-1422 Ph: (208) 745-6536 |
NPI Number | 1467611624 |
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Provider Enumeration Date | 06/03/2008 |
Last Update Date | 06/03/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467611624 | NPI | - | NPPES |
181636 | Other | IDAHO SMILES | |
001264500 | Medicaid | ID | |
476086 | Other | UNITED CONCORDIA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | D1758 (Idaho) | Primary |
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