Individual
SCOTT WILLIAM PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
310 N 400 E, NEPHI, UT 84648-1558
(435) 623-1916
(435) 623-7137
Mailing address
310 N 400 E, NEPHI, UT 84648-1558
(435) 623-7137
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6508547-9922
UT
Other
Enumeration date
06/26/2007
Last updated
07/08/2007
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