NPI age
7 years
Enumerated 2018-06-10
● Active
Type 1 · Individual
DR. Samuel Petersen, DMD
Petersen is 1 of 19 dentist providers in Eagle and 1 of 1099 in Idaho.
Primary specialty
Dentist
Plus 1 subspecialty
Licensed in
ID, KY
2 states
Status
Active
No deactivations on record
Last NPPES update
2024-02-28
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 1099 active dentist providers in Idaho.
NPI age
7 years
↓ 11 yr below median (18 yr)
State licenses
2 states
Top 92% — 7% of peers are multi-state
Subspecialties
1
In the 12% of peers with subspecialties
NPI lifetime · 2018 → 2026
2018-06Enumerated in NPPES
2018
2026
Where they practice
Practice location
450 W State St Ste 115
Eagle, ID 836167055
Mailing address
450 W State St Ste 115
Eagle, ID 836167055
Additional practice locations
2 secondary locations on file with NPPES.
Location 2
6700 N Linder Rd Ste 132
Meridian, ID 83646
Location 3
6700 N Linder Rd Ste 132
Meridian, ID 83646
Specialties
-
Dentist PrimaryA general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
-
DentistA dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two...
Practice context
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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