Petersen, Samuel

Petersen, Samuel is an sole proprietor health care provider with primary practice located at 450 W State St Ste 115 , Eagle ID 83616-7055. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is his primary health care specialty. Petersen, Samuel can be contacted via phone (208) 370-5203.

Contact Information

Primary practice address
450 W State St Ste 115 Eagle ID 83616-7055
Phone: (208) 370-5203
Fax: (208) 370-5204
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 10136 Kentucky
Dental Providers / General Practice 1223G0001X D-5038 Idaho

Profile Details

NPI number 1720571284
LBN Legal business name Petersen, Samuel
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 10th, 2018
Last updated Feb 28th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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