Individual
DR. GRANT DEE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1060 GAFFNEY RD STOP 7500, FORT WAINWRIGHT, AK 99703-5007
(907) 353-5530
(317) 361-5530
Mailing address
1060 GAFFNEY RD STOP 7500, FORT WAINWRIGHT, AK 99703-5007
(580) 442-4002
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN.00201800
CO
Other
Enumeration date
08/03/2012
Last updated
07/16/2013
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