DR. JUSTIN THOMAS PETERSON (NPI# 1386955029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386955029 |
| Entity Type | Individual |
| Full Name | DR. JUSTIN THOMAS PETERSON |
| Credential | D.D.S. |
| Practice Address |
325 E Main St Saint Anthony ID 83445-1546 |
| Mailing Address |
2205 Channing Way Suite B Idaho Falls ID 83404 |
| Practice Telephone | 2083564900 |
| Practice Fax Number | 2086244117 |
| Mailing Telephone | 2085293660 |
| Mailing Fax Number | 2085293666 |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2020-04-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D4293 | ID | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 72 S 1st E, Rexburg, ID 834401902 | 2083564900 | 2083563724 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285165472 | Justin D. Peterson | Internal Medicine | 72 E. Newton St, Ste 124, Boston, MA 02118-2308 | 2017-03-21 |
| 1811336241 | Justin Peterson | Surgery | Ky Clinic General Surgery, 740 S Limestone, Lexington, KY 40536-0001 | 2013-06-19 |
| 1649879297 | Justin Peterson | Recreation Therapist | 17273 State Route 104, Chillicothe, OH 45601-9718 | 2020-10-23 |
| 1174948012 | Justin Ross Peterson | Internal Medicine | 101 Bodin Cir., 60 Mdg/sgopc, Travis Afb, CA 94535-1809 | 2014-03-01 |
| 1033558010 | Justin William Peterson | Orthopaedic Surgery | 1 Genesys Pkwy, Grand Blanc, MI 48439-8065 | 2013-06-23 |
| 1073893616 | Justin Peterson | Obstetrics & Gynecology | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2011-08-26 |
| Street Address |
325 E MAIN ST |
| City | SAINT ANTHONY |
| State | ID |
| Zip Code | 83445-1546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053770230 | Upper Valley Community Health Services, Inc. | Clinic/Center | 325 E Main St, Saint Anthony, ID 83445-1546 | 2016-02-17 |
| 1679738397 | Kent A Beesley | Dentist | 325 E Main St, Saint Anthony, ID 83445 | 2008-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811419930 | Kasey Hendricks | Dentist | 322 East Main St., St. Anthony, ID 83445 | 2017-07-11 |
| 1235253808 | Northfork Developmental Services Inc. | Day Training, Developmentally Disabled Services | 104 N Bridge St, Suite #117, Saint Anthony, ID 83445 | 2007-03-19 |
| 1104970326 | Fremont Joint School District #215 | Local Education Agency (LEA) | 147 2nd W Street, St. Anthony, ID 83445 | 2007-01-23 |
| 1518109974 | Expressions Supportive Services, LLC | Community/Behavioral Health | 1076 A S. Yellowstone Hwy, Saint Anthony, ID 83445-0283 | 2009-04-01 |
| 1225294333 | Todd F Birch.o.d. | Optometrist | 45 W 1st N, Saint Anthony, ID 83445-1401 | 2008-07-29 |
| 1346391513 | Stephen J. Cheyne | General Practice | 430 N Bridge St, Saint Anthony, ID 83445-1425 | 2007-01-15 |
| 1952654741 | I Care Medical Clinic Pa | Physician Assistant | 430 N Bridge St, Saint Anthony, ID 83445-1425 | 2012-10-18 |
| 1023288172 | Fremont Medical Services PC | Clinic/Center | 430 N Bridge St, Saint Anthony, ID 83445-1425 | 2008-03-05 |
| 1932635810 | Teton Pharmacy of St Anthony | Pharmacy | 104 N Bridge St, Suite 112, Saint Anthony, ID 83445-1455 | 2017-05-11 |
| 1972940229 | Vonda Smith | Social Worker | 104 N Bridge St, #104, Saint Anthony, ID 83445-1455 | 2013-05-28 |
| Find all providers in zip 83445 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639225576 | John R.f. Toenjes | Dentist | 305 E 5th N, Saint Anthony, ID 83445-1626 | 2007-01-25 |
| 1225326747 | Ryan Douglas Smith | Dentist | 24 E 3rd S, Saint Anthony, ID 83445-1809 | 2011-07-18 |
| 1184836249 | Toenjes Brizzee & Orme Pa | Dentist | 305 E 5th N, Saint Anthony, ID 83445-1626 | 2007-05-03 |
| 1952457863 | Neil L Kunz | Dentist | 305 E 5th N, Saint Anthony, ID 83445-1626 | 2007-01-25 |
| 1043366982 | Gabel C Brizzee | Dentist | 305 E 5th N, Saint Anthony, ID 83445-1626 | 2007-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891304556 | Birchwood Dental, Pllc | Dentist | 3325 N Ten Mile Rd Ste 140, Meridian, ID 83646-6951 | 2020-07-29 |
| 1588273635 | Atlantis Dental Care, P.a. | Dentist | 13238 W Persimmon Ln Ste 100, Boise, ID 83713-1968 | 2020-07-24 |
| 1235747338 | Dentists of Boise and Orthodontics, PC | Dentist | 7500 W State St Ste 110, Boise, ID 83714-6074 | 2020-07-15 |
| 1346895232 | Tejasi Avasare | Dentist | 8321 W Overland Rd, Boise, ID 83709-1640 | 2019-08-07 |
| 1740835248 | Braden Comstock | Dentist | 2329 N Merritt Creek Loop, Coeur D Alene, ID 83814-4950 | 2019-08-02 |
| 1902450430 | Jaren M Thueson | Dentist | 106 E 1st N, Rexburg, ID 83440-1614 | 2019-08-01 |
| 1528610359 | Melissa Marie Pysnak | Dentist | 8850 W Emerald St Ste 150, Boise, ID 83704-4809 | 2019-07-11 |
| 1811555758 | Daniel Whitesitt | Dentist | 14596 Id-41, Rathdrum, ID 83858 | 2019-06-05 |
| 1104483122 | Meghan Cyrena Bristlin | Dentist | 3326 4th St Ste 3, Lewiston, ID 83501-4455 | 2019-05-24 |
| 1124684584 | Trevor Tafoya Dds Victory Dental, Pllc | Dentist | 7421 W Victory Rd, Boise, ID 83709-5106 | 2019-05-11 |
| Find all providers with the same taxonomy | ||||
| City | SAINT ANTHONY |
| Zip Code | 83445 |
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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.