IndividualActive
Samuel Petersen, DMD
NPI 1720571284 · General Practice Dentistry · Eagle, ID
Samuel Petersen, DMD is a General Practice Dentistry provider in Eagle, ID (NPI 1720571284).
Provider details
- NPI number
- 1720571284
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- License
- 10136 (KY)
Specialties & taxonomies
Dental Providers
Dental Providers
Profile Score
Detailed profile(77/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
3 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
450 W State St Ste 115
Eagle, ID 83616-7055
Phone: (208) 370-5203
Fax: (208) 370-5204
Street-level locationGet directions
Mailing address
450 W State St Ste 115
Eagle, ID 83616-7055
Additional practice locations (2)
- 6700 N Linder Rd Ste 132Meridian, ID 83646Phone: (208) 639-9480
- 6700 N Linder Rd Ste 132Meridian, ID 83646Phone: (208) 639-9480
Registry dates
- Enumerated
- 2018-06-10
- Last updated
- 2024-02-28
- Certified
- 2024-02-07
Frequently asked questions
- What is Samuel Petersen's NPI number?
- Samuel Petersen's National Provider Identifier (NPI) is 1720571284, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Samuel Petersen's specialty?
- Samuel Petersen is listed in the NPPES registry with a primary specialty of General Practice Dentistry (Dental Providers).
- Where is Samuel Petersen located?
- Samuel Petersen's practice location on file with NPPES is 450 W State St Ste 115, Eagle, ID 83616-7055.
- What is Samuel Petersen's phone number?
- The practice phone number listed in the NPPES registry for Samuel Petersen is (208) 370-5203.
- Is Samuel Petersen's NPI active?
- Yes — Samuel Petersen's NPI (1720571284) is active in the NPPES registry as of the last update on 2024-02-28.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.