Ty Peterson, DMD is a
Dentist - General Practice based in Gooding, Idaho. Ty Peterson is licensed to practice in Idaho (license number D-5035) and his current practice location is
325 Main St, Gooding, Idaho. He can be reached at his office (for appointments etc.) via phone at
(208) 934-8080.
NPI number for Ty Peterson is 1689234437 and his current mailing address is 325 Main St, Gooding, Idaho. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1689234437.
Healthcare Provider's Profile
| Full Name | Ty Peterson |
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| Gender | Male |
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| Speciality | Dentist - General Practice |
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| Location | 325 Main St, Gooding, Idaho |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1689234437
- Provider Enumeration Date: 06/14/2019
- Last Update Date: 06/14/2019
Medical Identifiers
Medical identifiers for Ty Peterson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1689234437 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223G0001X | Dentist - General Practice | D-5035 (Idaho) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ty Peterson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ty Peterson, DMD
325 Main St,
Gooding, ID 83330-1302
Ph: () - | Ty Peterson, DMD
325 Main St,
Gooding, ID 83330-1302
Ph: (208) 934-8080 |
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