National Provider Identifier Database

KELSEY PETERSON, DMD – NPI #1396069712
General Practice

A 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.


Contact Information

KELSEY PETERSON, DMD
1312 SOUTH WASHINGTON STREET
EMMETT, ID83617
Phone: 208-941-6640
Fax:
Website:
Specialty Taxonomy Code
* General Practice 1223G0001X
Orthodontics and Dentofacial Orthopedics 1223X0400X

* Indicates primary specialty

NPI Profile & details for KELSEY PETERSON

NPI Number 1396069712
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 03/15/2010
Last updated 02/13/2024 - About 2 years ago
Sole proprietor1 Yes
Identifiers
  • ID License #: D-4282
  • ID License #: D-4282-OR
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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