# J. DAYNE PETERSEN M.D., PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NuVista Plastic Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346597507
- **Authorized official:** DR. JASON DAYNE PETERSEN M.D. (PRESIDENT)
- **Authorized official phone:** (801) 971-8684

## Contact information

- **Practice address:** 5353 S 960 E, \#150, SALT LAKE CITY, UT 84117-3569
- **Practice address phone:** (801) 261-5791
- **Practice address fax:** (801) 747-7740
- **Mailing address:** 5353 S 960 E, \#150, SALT LAKE CITY, UT 84117-3569
- **Mailing address phone:** (801) 261-5791
- **Mailing address fax:** (801) 747-7740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 83185641205 | UT | Yes |

## Other

- **Enumeration date:** 08/07/2012
- **Last updated:** 08/30/2012