Individual
DR. CHAD WILLIAM PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6238 YELLOWSTONE RD, CHEYENNE, WY 82009-3432
(307) 635-6940
(307) 635-2839
Mailing address
6238 YELLOWSTONE RD, CHEYENNE, WY 82009-3432
(307) 635-6940
(307) 635-2839
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1436
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145967800
—
WY
Enumeration date
04/10/2013
Last updated
12/12/2020
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