Wayne R. Peterson, DMD, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D-3654 Issued in ID

Legal business name

WAYNE R. PETERSON, DMD, PC

Practice address

2427 N Cole Rd
Boise, ID 83704-5907

Phone

(208) 322-8877

NPI assigned

Aug 26, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Wayne R Peterson, DMDNPI 1194803577

Title

President

Phone

(208) 322-8877

Specialties & licenses 1

Addresses

Practitioners 1

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

• Wayne R Peterson, D.M.D.

  • General Practice Dentistry
  • Boise, ID
  • NPI 1194803577
  NPD (past) Authorized official

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

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1205083714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2427 N COLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045907",
            "telephone_number": "208-322-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2427 N COLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045907",
            "telephone_number": "208-322-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE R. PETERSON, DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-322-8877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D-3654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Waverek, M.S. CCC-SLP
• Dylan Anthony Wayman, LMT, CPT, NMT
• Kristi L Wayment, PA-C
• Wayne Counseling, LLC
• Wayne Mortensen DMD PC
• Danielle Wayne, LCSW, LISW
• Coire Weathers, MD
• Emmy Laurie Weathers, MSW, LMSW
• Kathleen A Weathers, LCPC
• Matthew Caleb Weaver

• Dental Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.