| Peterson Dental | |
|
127 1/2 E Short St Rigby ID 83442-1422 | |
| (208) 745-6536 | |
| (208) 745-0006 |
| Full Name | Peterson Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 127 1/2 E Short St, Rigby, Idaho |
| Authorized Official Name and Position | Mark L Peterson (DENTIST) |
| Authorized Official Contact | 2087456536 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peterson Dental 127 1/2 E Short St Rigby ID 83442-1422 Ph: (208) 745-6536 | Peterson Dental 127 1/2 E Short St Rigby ID 83442-1422 Ph: (208) 745-6536 |
| NPI Number | 1467611624 |
|---|---|
| Provider Enumeration Date | 06/03/2008 |
| Last Update Date | 06/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467611624 | NPI | - | NPPES |
| 181636 | Other | IDAHO SMILES | |
| 001264500 | Medicaid | ID | |
| 476086 | Other | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D1758 (Idaho) | Primary |
Rigby Dental, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 127 1/2 E Short St, Rigby, ID 83442 Phone: 208-745-6536 Fax: 208-745-0006 | |
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