Individual
DR. TYSON DON PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1260 N 200 E, LOGAN, UT 84341-7560
(435) 752-8000
Mailing address
763 E 350 S, SMITHFIELD, UT 84335-1325
(435) 730-6233
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10387670-9923
UT
1223G0001X
General Practice Dentistry
4774
ID
Other
Enumeration date
08/18/2016
Last updated
07/21/2022
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