NPIMap

Organization Active NPI

Wayne Peterson DMD PC

  • Dentist
  • Moscow, ID
National Provider Identifier
1134389281
Registry record updated Jun 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D1686 Issued in ID
Legal business name
WAYNE PETERSON DMD PC
Practice address
1138 West a St
Moscow, ID 83843
Phone
(208) 882-9310
Fax
(208) 882-8601
NPI assigned
Jun 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2008

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

Authorized official

Name
Dr. Wayne Michael Peterson, DMDNPI 1235179466
Title
President
Phone
(208) 882-9310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D1686 ID Primary

Addresses

Primary practice location

1138 West a St
Moscow, ID 83843

Mailing address

1138 West a St
Moscow, ID 83843
Phone (208) 882-9310

National Provider Directory

National Provider Directory

Locations

1138 W A St
Moscow, ID 83843
Phone (208) 882-9310

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1134389281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 WEST A ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "83843",
            "telephone_number": "208-882-9310",
            "fax_number": "208-882-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 WEST A ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "83843",
            "telephone_number": "208-882-9310",
            "fax_number": "208-882-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE PETERSON DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-12",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-882-9310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D1686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.