# PETERSON FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083873400
- **Authorized official:** DR. JOHN G PETERSON DMD (DENTIST)
- **Authorized official phone:** (208) 375-0185

## Contact information

- **Practice address:** 9201 W OVERLAND RD, BOISE, ID 83709-2502
- **Practice address phone:** (208) 375-0185
- **Practice address fax:** (208) 375-0305
- **Mailing address:** 9201 W OVERLAND RD, BOISE, ID 83709-2502
- **Mailing address phone:** (208) 375-0185
- **Mailing address fax:** (208) 375-0305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3921 | ID | Yes |

## Other

- **Enumeration date:** 06/02/2008
- **Last updated:** 06/02/2008