DR. SAMUEL PETERSEN DMD
NPI 1720571284
Dentist - General Practice in Eagle, ID

Q: What is Samuel Petersen's NPI number?

The NPI number for Samuel Petersen is 1720571284. It was assigned to this individual provider in the NPPES registry on June 10, 2018.

Q: What is Samuel Petersen's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Petersen was last updated on February 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 10, 2018

450 W STATE ST STE 115, EAGLE, ID 83616(208) 370-5203(208) 370-5204 Get Directions Write a Review

NPPES record last updated: February 28, 2024. Verified against the NPPES registry weekly; last sync: September 06, 2026.

On this page

About Dr. Samuel Petersen Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SAMUEL PETERSEN DMD (NPI 1720571284) is an individual general practice provider in Eagle, Idaho, licensed in Idaho (D-5038) and active in the NPI registry since June 2018. He maintains a secondary practice location in Meridian.

NPPES Registry Identity

NPI1720571284

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. SAMUEL PETERSENCredential: DMD

Location Address450 W STATE ST STE 115Eagle, ID 83616-7055

Mailing Address450 W State St Ste 115Eagle, ID 83616-7055 · (208) 370-5203 · Fax (208) 370-5204

Phone(208) 370-5203

Fax(208) 370-5204

Sole ProprietorYes

Enumeration DateJune 10, 2018

Last NPPES UpdateFebruary 28, 2024

NPPES CertifiedFebruary 7, 2024

✔ NPI 1720571284 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in ID · D-5038

Definition

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.

Also ListedDentistTaxonomy 122300000X · License 10136 (KY)

450 W STATE ST STE 115, Eagle, ID 83616

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Secondary Practice Location 1

Location 16700 N Linder Rd Ste 132Meridian, ID 83646 · Phone (208) 639-9480

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. GARY MICHAEL ALTENBURG DDS

Dentist (Endodontics)

450 W STATE ST STE 115
EAGLE, ID 83616

Ada County (208) 286-4200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Petersen's NPI number?

The NPI number for Samuel Petersen is 1720571284. It was assigned to this individual provider in the NPPES registry on June 10, 2018.

Where is Samuel Petersen located?

Samuel Petersen practices at 450 W State St Ste 115, Eagle, ID 83616. The listed phone number is (208) 370-5203.

What is Samuel Petersen's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

What insurance does Samuel Petersen accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 4 other insurers list Samuel Petersen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Samuel Petersen was last updated on February 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.