Individual
DANIEL BRYCE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
420 POLIFKA DR BLDG 1042, SHAW AFB, SC 29152-5100
(803) 895-6951
Mailing address
420 POLIFKA DR BLDG 1042, SHAW AFB, SC 29152-5100
(803) 695-6988
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10414
SC
Other
Enumeration date
04/21/2021
Last updated
11/25/2024
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