Dr. Tyson Peteresn

NPI #1972121770 in Logan, Utah

Provider Information

NPI Number: 1972121770
Entity Type: Organization
Organization Name: Dr. Tyson Peteresn
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Jul 8, 2020
Last Updated: Jul 8, 2020

Practice Location

Address: 110 E 200 N
City: Logan
State: Utah
ZIP Code: 84321-4007
Phone: (435) 752-0300

Authorized Official

Name: DR. TYSON PETERSEN, DDS
Title: DR
Phone: (435) 752-0300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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