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MARK L. PETERSON NPI 1467611624


NPI Information

NPI: 1467611624
Provider Name: MARK L. PETERSON

Doing Business As: PETERSON DENTAL

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
127 1/2 E SHORT ST
RIGBY, ID
ZIP 83442
Phone: (208) 745-6536
Get Directions

MARK L. PETERSON is a general practice dentist in Rigby, ID. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. MARK L. PETERSON NPI is 1467611624. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Peterson Dental.

The provider's business location address is:

127 1/2 E SHORT ST
RIGBY, ID
ZIP 83442-422
Phone: (208) 745-6536
Fax: (208) 745-0006

The provider's authorized official is Mark L Peterson .
The authorized official title is Dentist and has the following contact phone number (208) 745-6536.

The enumeration date for this NPI number is 6/3/2008 and was last updated on 6/3/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral PracticeD1758IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1001264500MEDICAIDIDAHO
2476086OTHERUNITED CONCORDIA
3181636OTHERIDAHO SMILES

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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