Organization
GRANGER PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HANS C PETERSEN DMD (OWNER/DENTIST)
(801) 969-8881
Entity
Organization
Contact information
Practice address
GRANGER PEDIATRIC DENTISTRY, 3535 S MARKET STREET SUITE #145, WEST VALLEY CITY, UT 84119-3637
(801) 969-8881
(801) 969-8889
Mailing address
GRANGER PEDIATRIC DENTISTRY, P.O. BOX 18430, SALT LAKE CITY, UT 84118-0430
(801) 969-8881
(801) 969-8889
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
360305-9923
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
526155793003
—
UT
Enumeration date
08/19/2010
Last updated
03/21/2025
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