Provider Demographics
NPI:1558663120
Name:LEHI PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:LEHI PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-766-5557
Mailing Address - Street 1:216 E MAIN ST.
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2231
Mailing Address - Country:US
Mailing Address - Phone:801-768-0541
Mailing Address - Fax:801-768-0541
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:SUITE #3
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2231
Practice Address - Country:US
Practice Address - Phone:801-768-0541
Practice Address - Fax:801-768-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5323980-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental