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Organization

PINNACLE ADVANCED DENTISTRY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SCOTT WILLIAM PETERSEN DMD (MANAGER)
(435) 623-1916
Entity
Organization

Contact information

Practice address
310 N 400 E, NEPHI, UT 84648-1558
(435) 623-1916
Mailing address
310 N 400 E, NEPHI, UT 84648-1558
(435) 623-1916

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1295931046
NPI NUMBER
UT
01
1992052401
NPI NUMBER
Enumeration date
12/14/2022
Last updated
12/14/2022
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