Provider Demographics
NPI:1255497079
Name:PETERSEN, HANS C (DMD)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:C
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 EAST MAIN STREET
Mailing Address - Street 2:#C
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6634
Mailing Address - Country:US
Mailing Address - Phone:801-766-5557
Mailing Address - Fax:801-768-0541
Practice Address - Street 1:216 EAST MAIN STREET
Practice Address - Street 2:#C
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6634
Practice Address - Country:US
Practice Address - Phone:801-766-5557
Practice Address - Fax:801-768-0541
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53239801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry