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Dr. Tyson Peteresn
Dental Clinic/Center in Logan, Utah
NPI 1972121770

Dr. Tyson Peteresn is a Dental Clinic/Center based in Logan, UT and is specialized in Dental. Dr. Tyson Peteresn practices in Logan, UT. The NPI Number for Dr. Tyson Peteresn is 1972121770 and holds a License No. (Utah).

The current practice location address for Dr. Tyson Peteresn is 110 E 200 N, Logan, UT and can be reached out via phone at 435-752-0300 and via fax at 435-755-7625.

Location: 110 E 200 N, Logan, UT, 84321-4007
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1972121770
Provider Name
Dr. Tyson Peteresn
Credential
Provider Entity Type
Organization
Address
110 E 200 N, Logan, UT, 84321-4007
Phone Number
435-752-0300
Fax Number
435-755-7625
Provider Enumeration Date
07/08/2020
Last Update Date
03/10/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
PE1 01 UT DENTAL
institution
Provider Business Practice Location Address Details
Address
110 E 200 N
City
Logan
State
Utah
Zip
84321-4007
Phone Number
435-752-0300
Fax Number
435-755-7625
person
Provider Business Mailing Address Details
Address
110 E 200 N
City
Logan
State
Utah
Zip
84321-4007
Phone Number
435-752-0300
Fax Number
435-755-7625
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Dental
Taxonomy
261QD0000X
License No.
()
Definition
Definition to come...
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