Individual
DR. BYRON THAD PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
GEORGE E WAHLEN DEPT OF VETERANS AFFAIRS MEDICAL CTR, 500 FOOTHILL DRIVE, DENTAL SERVICE (160), SALT LAKE CITY, UT 84148-0001
(801) 584-1206
(801) 584-1251
Mailing address
2162 E. CREEK ROAD, SANDY, UT 84093-6448
(801) 942-2631
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
135438-9923
UT
Other
Enumeration date
08/14/2006
Last updated
07/08/2007
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