JAKE ALLEN PETERSON


Address: 3003 W Main St Ste 130, Boise, ID 83702-2026
Phone: 2083427610

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).

Provider Overview

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

Taxonomy

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

Provider Secondary Practice Location

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

Office Location

Street Address 3003 W MAIN ST STE 130
City BOISE
State ID
Zip Code 83702-2026

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 1223S0112X
Grouping Dental Providers
Classification Dentist
Specialization Oral and Maxillofacial Surgery

Taxonomy Definition

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

Providers in the same taxonomy and city

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

Competitor

Search similar providers

City BOISE
Zip Code 83702

Improve Information

Please comment or provide details below to improve the information on JAKE ALLEN PETERSON.

Dataset Information

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.

Trending Searches