Peterson Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3921 Issued in ID

Legal business name

PETERSON FAMILY DENTISTRY

Practice address

9201 W Overland Rd
Boise, ID 83709-2502

Phone

(208) 375-0185

Fax

(208) 375-0305

NPI assigned

Jun 2, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John G Peterson, DMDNPI 1295875953

Title

Dentist

Phone

(208) 375-0185

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Gregory Peterson, DMD

  • Dentist
  • Boise, ID
  • NPI 1295875953
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1083873400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 W OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837092502",
            "telephone_number": "208-375-0185",
            "fax_number": "208-375-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 W OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837092502",
            "telephone_number": "208-375-0185",
            "fax_number": "208-375-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-375-0185",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "3921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krista I Petersen, FNP-C
• Lucas Cedric Petersen
• Nicole Lynne Petersen
• Robert L Petersen, MD
• Sarah Brienne Petersen
• Peterson Thrive Therapy
• Lauri Peterson Peterson-Carey
• Andrew Albert Peterson, M.D.
• Anna Jeannette Peterson, DO
• Christian Peterson, MD

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.