Organization
TAYNE A PETERSON DMD PLLC
Active
Other names
BURLEY FAMILY DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAYNE PETERSON DMD (SOLE MBR)
(208) 670-4428
Entity
Organization
Contact information
Practice address
2200 PARK AVE STE 2, BURLEY, ID 83318-2186
(208) 878-6684
Mailing address
2200 PARK AVE STE 2, BURLEY, ID 83318-2186
(208) 878-6684
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/27/2022
Last updated
09/07/2022
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