Tayne a Peterson DMD PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

TAYNE A PETERSON DMD PLLC

Practice address

2200 Park Ave Ste 2
Burley, ID 83318-2186

Phone

(208) 878-6684

NPI assigned

Jul 27, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Tayne Peterson, DMDNPI 1952960205

Title

Sole MBR

Phone

(208) 670-4428

Specialties & licenses 1

Addresses

Other names 1

• BURLEY FAMILY DENTAL Doing business as

Locations

Practitioners 1

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

• Tayne Peterson

  • General Practice Dentistry
  • Burley, ID
  • NPI 1952960205
  NPD Authorized official

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

{
    "created_epoch": "1658880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1942936406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 PARK AVE STE 2",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182186",
            "telephone_number": "208-878-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 PARK AVE STE 2",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182186",
            "telephone_number": "208-878-6684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAYNE A PETERSON DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-27",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "TAYNE",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "208-670-4428",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BURLEY FAMILY DENTAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BURLEY FAMILY DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Scott Cory Stuart, PA-C
• Michael Bryson Stucki, DDS
• Hannah Terra
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• Robert Keller Thompson, PHARMD
• Thrifty Payless Inc

• Dental Clinic/Center in Burley, ID
• Providers in Burley, 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 Sep 7, 2022; 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.