Individual
DR. DOUGLAS A PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
310 N 400 E, NEPHI, UT 84648-1558
(435) 623-1918
(435) 623-7137
Mailing address
310 N 400 E, NEPHI, UT 84648-1558
(435) 623-1918
(435) 623-7137
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5130379-9922
UT
Other
Enumeration date
02/23/2007
Last updated
07/08/2007
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