Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1720571284 Individual Practitioner Male Practitioner

Dr. Samuel Petersen , DMD

Dentist - General Practice • Eagle, ID

Professional Overview & Biography Verified Profile Summary

Dr. Samuel Petersen, DMD is a registered healthcare professional specializing in Dentist - General Practice in Eagle, ID. Practice services are available at 450 W STATE ST STE 115 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

450 W State St Ste 115

Eagle, ID 836167055

Telephone 2083705203
Fax 2083705204

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Eagle, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 28.3 Yrs
Regional Practice Density
17 Specialists

Practicing in Eagle, ID (781 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-02-07
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License ID D-5038

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.

Dentist

NUCC Taxonomy Code: 122300000X

State License KY 10136

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Secondary Practice Locations

6700 N Linder Rd Ste 132

Meridian, ID 83646

Phone: 2086399480

6700 N Linder Rd Ste 132

Meridian, ID 83646

Phone: 2086399480

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Gary Altenburg , DDS

Dentist - Endodontics

NPI 1356558852

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
📍
Updated Practice Location February 28, 2024

Registered at 450 W STATE ST STE 115, EAGLE, ID 836167055 (Tel: 2083705203)

📍
Updated Business Mailing Address February 28, 2024

Registered at 450 W STATE ST STE 115, EAGLE, ID 836167055 (Tel: 2083705203)

📍
Updated Practice Location July 30, 2019

Registered at 6700 N LINDER RD STE 132, MERIDIAN, ID 83646 (Tel: 2086399480)

📍
Updated Business Mailing Address July 30, 2019

Registered at 5066 N ABERDEEN PL, MERIDIAN, ID 836465603 (Tel: 2082404649)

👤
Provider Name / Credentials Updated July 30, 2019

Recorded as SAMUEL PETERSEN, DMD

NPI Profile Active June 10, 2018

NPI status registered as active in NPPES database

📍
Updated Practice Location June 10, 2018

Registered at 3701 HOPEWELL RD, LOUISVILLE, KY 402995392 (Tel: 5022665661)

📍
Updated Business Mailing Address June 10, 2018

Registered at 1910 WESTMOORLAND WAY, LOUISVILLE, KY 402423447 (Tel: 2082404649)

👤
Provider Name / Credentials Updated June 10, 2018

Recorded as SAMUEL PETERSEN

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 10, 2018

Dentist (License #10136 in KY)

🟢
Initial NPI Registration & Enumeration June 10, 2018

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1720571284
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 10, 2018
Last Update: February 28, 2024
Sole Proprietor: Yes

Mailing Address

450 W State St Ste 115

Eagle, ID 836167055

Phone: 2083705203

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.