Tayne Peterson
General Dentistry · Burley, ID
UnclaimedNPI 1952960205
- Primary taxonomy
- 1223G0001X
- Enumerated
- 2019-06-11
- Practice location
- Burley, ID
- Last NPPES update
- 2022-09-07
State licenses
- ID · Dentist · NPPES self-reportedListed on NPI record
“Listed on NPI record” means the provider reported this license to NPPES; other statuses come from the state board’s public records as of the last import. License numbers are not shown.
Source: CMS National Plan & Provider Enumeration System (NPPES) and state licensing boards. ScrubHub shows name, credential, taxonomy, practice city/state and license status only.