| Petersen Dental Llc | |
|
10458 S Redwood Rd South Jordan UT 84095-8501 | |
| (801) 302-8989 | |
| (801) 302-8989 |
| Full Name | Petersen Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 10458 S Redwood Rd, South Jordan, Utah |
| Authorized Official Name and Position | Luke Petersen (OWNER) |
| Authorized Official Contact | 8013028989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Petersen Dental Llc 10458 S Redwood Rd South Jordan UT 84095-8501 Ph: (801) 302-8989 | Petersen Dental Llc 10458 S Redwood Rd South Jordan UT 84095-8501 Ph: (801) 302-8989 |
| NPI Number | 1417315656 |
|---|---|
| Provider Enumeration Date | 02/02/2016 |
| Last Update Date | 02/02/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417315656 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 7702761-99021 (Utah) | Primary |
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