TAYNE PETERSON

BURLEY, ID
NPI1952960205
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: ID  D-5401)
Enumeration Date2019-06-11
Last Update Date2022-09-07
Business Address
TAYNE PETERSON
2200 PARK AVE STE 2
BURLEY, ID 83318-2186
Phone number: 208-878-6684
Mailing Address
TAYNE PETERSON
2200 PARK AVE
BURLEY, ID 83318-2186
Phone number: 208-878-6684
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