JAKE ALLEN PETERSON (NPI# 1043657364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1043657364 |
Entity Type | Individual |
Full Name | JAKE ALLEN PETERSON |
Credential | DDS, MD |
Practice Address |
3003 W Main St Ste 130 Boise ID 83702-2026 |
Practice Telephone | 2083427610 |
Mailing Telephone | 2083427610 |
Enumeration Date | 2013-05-28 |
Last Update Date | 2020-08-18 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
M-15171 | ID | Dental Providers |
Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D-5107-OS | ID | Dental Providers |
N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DE60941667 | WA | Dental Providers |
Address | Telephone Number | Fax Number |
---|---|---|
11575 West State St, Star, ID 83669 | 2082867755 | 2082867447 |
1502 Locus St N, Suite 103, Bldg 100, Twin Falls, ID 83301 | 2085373700 | |
304 N Main St, Hailey, ID 833338415 | 2087885308 | 2089068026 |
Street Address |
3003 W MAIN ST STE 130 |
City | BOISE |
State | ID |
Zip Code | 83702-2026 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1376593640 | Eric Webb Nelson | Dentist | 3003 W Main St Ste 130, Boise, ID 83702-2026 | 2006-05-10 |
1104248053 | Whitewater Oral Surgery Group Pllc | Dentist | 3003 W Main St Ste 130, Boise, ID 83702-2026 | 2014-01-13 |
1831496843 | Justin Hastings | Oral & Maxillofacial Surgery | 3003 W Main St Ste 130, Boise, ID 83702-2026 | 2011-02-28 |
1255435459 | Kevin G Kempers | Dentist | 3003 W Main St Ste 130, Boise, ID 83702-2026 | 2006-09-11 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
Find all providers in zip 83702 |
Taxonomy Code | 1223S0112X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Oral and Maxillofacial Surgery |
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
Notes: Source: Council on Dental Education and Licensure, American Dental Association |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124433743 | Arman Haghighi | Dentist | 403 S 11th St Ste 300, Boise, ID 83702-6968 | 2014-06-23 |
1013274661 | Treasure Valley Oral and Facial Surgery Pllc | Dentist | 1000 N. Curtis Rd, Suite 103, Boise, ID 83706 | 2012-04-20 |
1790892610 | Bruce Morrison | Dentist | 6363 W Emerald St, Suite 103, Boise, ID 83704-8783 | 2006-08-24 |
1457378382 | Dean C. Younce, Dmd, Pa | Dentist | 5266 N Eagle Rd, Boise, ID 83713-0945 | 2006-07-16 |
1891727582 | Michael R Bailey | Dentist | 403 South 11th Street, Suite 300, Boise, ID 83702-6906 | 2006-07-06 |
1982650404 | Victor D Cook | Dentist | 7910 Ustick Rd, Boise, ID 83704-5850 | 2006-05-26 |
1104248053 | Whitewater Oral Surgery Group Pllc | Dentist | 3003 W Main St Ste 130, Boise, ID 83702-2026 | 2014-01-13 |
1699949750 | Boise Oral and Maxillofacial Surgery | Dentist | 6363 W Emerald St, Suite 103, Boise, ID 83704-8783 | 2008-04-18 |
1053584284 | Michael R Bailey Md Dds Pa | Dentist | 403 S 11th St, Suite 300, Boise, ID 83702-6968 | 2008-04-09 |
1811169733 | Dean Younce | Dentist | 5266 N Eagle Rd, Boise, ID 83713-0945 | 2008-04-01 |
Find all providers in BOISE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.