Tayne Peterson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-5401 Issued in ID

Practice address

2200 Park Ave Ste 2
Burley, ID 83318-2186

Phone

(208) 878-6684

Fax

(208) 678-3170

NPI assigned

Jun 11, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tayne a Peterson DMD PLLC

  dba Burley Family Dental

  • Dental Clinic/Center
  • Burley, ID
  • NPI 1942936406

  General Practice

  NPD Authorized official

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1952960205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 PARK AVE",
            "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",
            "fax_number": "208-678-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TAYNE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-11",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-5401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Oneal Parkinson, D.O.
• Pathways, Inc
• Temp Ray Patterson, MD
• Micalena Rose Perkins, MSN, APRN, CPNP
• Joseph R Petersen
• Deb Phillips, PHARMD
• Alan Scott Pickup, DMD
• Eric B Pierce, O.D.
• Brek Pilling, PHD
• Brandon Pope, PA-C

• General Practice Dentistry in Burley, ID
• Providers in Burley, 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 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.