NPIMap

Organization Active NPI

Granger Pediatric Dentistry

  • Dental Clinic/Center
  • West Valley City, UT
National Provider Identifier
1154637825
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
360305-9923 Issued in UT
Legal business name
GRANGER PEDIATRIC DENTISTRY
Practice address
Granger Pediatric Dentistry
3535 S Market Street Suite #145
West Valley City, UT 84119-3637
Phone
(801) 969-8881
Fax
(801) 969-8889
NPI assigned
Aug 19, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Hans C Petersen, DMDNPI 1255497079
Title
Owner/Dentist
Phone
(801) 969-8881

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 360305-9923 UT Primary

Addresses

Primary practice location

Granger Pediatric Dentistry
3535 S Market Street Suite #145
West Valley City, UT 84119-3637

Mailing address

Granger Pediatric Dentistry
P.O. Box 18430
Salt Lake City, UT 84118-0430
Phone (801) 969-8881

Other identifiers 1

IdentifierTypeStateIssuer
526155793003MedicaidUT

National Provider Directory

National Provider Directory

Locations

3725 W 4100 S
Ste 260
West Valley City, UT 84120

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1154637825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "GRANGER PEDIATRIC DENTISTRY",
            "address_2": "P.O. BOX 18430",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841180430",
            "telephone_number": "801-969-8881",
            "fax_number": "801-969-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GRANGER PEDIATRIC DENTISTRY",
            "address_2": "3535 S MARKET STREET SUITE #145",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193637",
            "telephone_number": "801-969-8881",
            "fax_number": "801-969-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-19",
        "last_updated": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "HANS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "801-969-8881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "UT",
            "license": "360305-9923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526155793003",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Valley City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.