# WAYNE PETERSON DMD PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1134389281
- **Authorized official:** DR. WAYNE MICHAEL PETERSON DMD (PRESIDENT)
- **Authorized official phone:** (208) 882-9310

## Contact information

- **Practice address:** 1138 WEST A ST, MOSCOW, ID 83843
- **Practice address phone:** (208) 882-9310
- **Practice address fax:** (208) 882-8601
- **Mailing address:** 1138 WEST A ST, MOSCOW, ID 83843
- **Mailing address phone:** (208) 882-9310
- **Mailing address fax:** (208) 882-8601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D1686 | ID | Yes |

## Other

- **Enumeration date:** 06/12/2008
- **Last updated:** 06/12/2008