Mark L. Peterson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D1758 Issued in ID

Legal business name

MARK L. PETERSON

Doing business as

Peterson Dental

Practice address

127 1/2 E Short St
Rigby, ID 83442-1422

Phone

(208) 745-6536

Fax

(208) 745-0006

NPI assigned

Jun 3, 2008

Last updated

Jun 3, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark L Peterson, DDSNPI 1689782864

Title

Dentist

Phone

(208) 745-6536

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Peterson Dental Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark L Peterson, DDS

  • General Practice Dentistry
  • Rigby, ID
  • NPI 1689782864
  NPD (past) Authorized official

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1467611624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 1/2 E SHORT ST",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834421422",
            "telephone_number": "208-745-6536",
            "fax_number": "208-745-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 1/2 E SHORT ST",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834421422",
            "telephone_number": "208-745-6536",
            "fax_number": "208-745-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK L. PETERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-745-6536",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001264500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "476086",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO SMILES",
            "identifier": "181636",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Life Center for Change
• Braden Lott, DPT
• Lotus Wellness Inc
• Julie Kaye Macki
• Madison Co Memorial Hospital (Rigby Medical Center)
• Tracy A McCuistion, D.C.
• Trent Robert McGary, D.P.T.
• Alissa McMinn, MS CCC-SLP
• Stephanie Meyer, CPM, LM
• Quinn Cooper Mikesell, D.M.D.

• General Practice Dentistry in Rigby, ID
• Providers in Rigby, 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 3, 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.