DR. SAMUEL GEORGE PETERSEN (NPI# 1780848119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780848119 |
| Entity Type | Individual |
| Full Name | DR. SAMUEL GEORGE PETERSEN |
| Credential | D.D.S. |
| Practice Address |
940 Sylva Ln Ste K1 Sonora CA 95370-5969 |
| Practice Telephone | 2095325578 |
| Practice Fax Number | 2095326216 |
| Mailing Telephone | 2095325578 |
| Mailing Fax Number | 2095326216 |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2008-07-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
51511 | CA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720571284 | Samuel Petersen | Dentist | 6700 N Linder Rd Ste 132, Meridian, ID 83646 | 2018-06-10 |
| Street Address |
940 SYLVA LN STE K1 |
| City | SONORA |
| State | CA |
| Zip Code | 95370-5969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174056089 | Chris Neves | Case Management | 427 N Highway 49, Suite 305, Sonora, CA 95370 | 2017-04-07 |
| 1528433885 | Michael French Dds Dental Corporation | General Acute Care Hospital | 800 Morningstar Dr, Sonora, CA 95370 | 2015-12-11 |
| 1942681465 | Amanda Evans | Registered Nurse | 20111 Cedar Rd North, Sonor, CA 95370 | 2015-06-10 |
| 1043625916 | Cicely Chen | Obstetrics & Gynecology | 900 Greenley Rd, Suite 922 Adventist Health (sierra Ob/, Sonora, CA 95370 | 2014-06-30 |
| 1457781692 | Donnie E Campbell | Homeopath | 63 South Stewart St, Sonora, CA 95370 | 2013-11-26 |
| 1386078186 | Jo Ann M Rascon | Marriage & Family Therapist | 38 N Washington St, Suite F, Sonora, CA 95370 | 2013-08-28 |
| 1831449735 | Sami Rhodes | Case Manager/Care Coordinator | 427 N. Highway 49, Sonora, CA 95370 | 2012-09-18 |
| 1619225273 | Melissa Parrish | Registered Nurse | 20111 Cedar Rd. North, Sonora, CA 95370 | 2012-08-29 |
| 1295033504 | Magdalena Martinez Bauman | Marriage & Family Therapist | 175 Fairview Ln., Sonora, CA 95370 | 2011-03-10 |
| 1588804215 | Holly Gwendolyn Harris | Physical Therapist | 15274 Camino Del Parque Rd. S, Sonora, CA 95370 | 2009-02-20 |
| Find all providers in zip 95370 | ||||
| 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 |
|---|---|---|---|---|
| 1972896785 | Sonora Oral & Maxillofacial Surgery Dental Group | Dentist | 940 Sylva Ln, Suite K-1, Sonora, CA 95370-5969 | 2011-05-26 |
| 1275652422 | Slim Bouchoucha | Dentist | 940 Sylva Ln, Suite K1, Sonora, CA 95370-5969 | 2007-03-28 |
| 1639298755 | Frederick R Mathews | Dentist | 940 Sylva Ln, Suite K1, Sonora, CA 95370-5969 | 2007-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807979 | Ayed Hawatmeh Dds Inc | Dentist | 322 E Foothill Blvd, Pomona, CA 91767 | 2020-10-02 |
| 1114533064 | Alexander V. Antipov, D.d.s., Inc. | Dentist | 911 Reserve Drive, Suite 150, Roseville, CA 95678 | 2020-09-16 |
| 1609493170 | Amir Haghshenas Dds | Dentist | 3880 S Bascom Ave Ste 213, San Jose, CA 95124-2675 | 2020-07-01 |
| 1316568900 | Beech & Reid Dental Partnership | Dentist | 464 E Calaveras Blvd Ste B3, Milpitas, CA 95035-5412 | 2020-05-05 |
| 1518506773 | Francisco Suarez, Dds Inc. | Dentist | 4606 Hollywood Blvd Ste A, Los Angeles, CA 90027-5462 | 2020-01-04 |
| 1831748839 | Slate Dental Corporation | Dentist | 6512 Lonetree Blvd Ste 100, Rocklin, CA 95765-5883 | 2019-09-11 |
| 1255980140 | Dr Maloux Macasaet Saguin Dental Corporation | Dentist | 9800 Topanga Canyon Blvd Ste J, Chatsworth, CA 91311-4075 | 2019-09-04 |
| 1891342267 | Amrollahie and Riman Dental Partnership | Dentist | 1442 Irvine Blvd Ste 225, Tustin, CA 92780-3846 | 2019-08-21 |
| 1548821572 | Hoang Dental Corporation | Dentist | 1356 W Valley Pkwy Ste J, Escondido, CA 92029-2138 | 2019-06-20 |
| 1073173860 | Omfs Care Center Partners | Dentist | 215 N Fresno St Ste 490, Fresno, CA 93701-0000 | 2019-06-14 |
| Find all providers with the same taxonomy | ||||
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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.