Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Samuel Petersen, DMD

Individual provider Dentist · NPI 1720571284

Dr. Samuel Petersen, DMD is a Dentist in Eagle, Idaho. Practices as a sole proprietor and works from 3 locations. Licensed in Idaho and Kentucky.

Licensed in
ID, KY
In the registry since
2018
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

450 W State St Ste 115
Eagle, ID 83616-7055
Phone: (208) 370-5203
Fax: (208) 370-5204
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 6700 N Linder Rd Ste 132, Meridian, ID 83646 — (208) 639-9480
  • 6700 N Linder Rd Ste 132, Meridian, ID 83646 — (208) 639-9480

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence D-5038 (ID)
Dentist Taxonomy 122300000X · Licence 10136 (KY)

Record details

NPI number1720571284
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorYes
NPI enumeratedJune 10, 2018
Last updated in NPPESFebruary 28, 2024
Certification dateFebruary 7, 2024
Mailing address450 W State St Ste 115, Eagle, ID 83616-7055

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