Petersen Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

License

7702761-99021 Issued in UT

Legal business name

PETERSEN DENTAL LLC

Practice address

10458 S Redwood Rd
South Jordan, UT 84095-8501

Phone

(801) 302-8989

Fax

(801) 302-8989

NPI assigned

Feb 2, 2016

Organization subpart

No

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

Authorized official

Name

Luke Petersen, DDS

Title

Owner

Phone

(801) 302-8989

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Kenneth John Liddiard, DMD

  • General Practice Dentistry
  • Pueblo, CO
  • NPI 1295792307
  NPD (past)

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

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454371200000",
    "number": "1417315656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10458 S REDWOOD RD",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958501",
            "telephone_number": "801-302-8989",
            "fax_number": "801-302-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10458 S REDWOOD RD",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958501",
            "telephone_number": "801-302-8989",
            "fax_number": "801-302-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-02",
        "last_updated": "2016-02-02",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-302-8989",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "7702761-99021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn M Pendleton, PA-C
• Brittany Permenter, ACMHC
• Tyler Perry, PA-C, ATC
• Personal Injury Center MD LLC
• Charli Danielle Peters, A.P.R. N
• Sarah Connors Petersen, MD
• Brad Niel Peterson, D.C.
• Catherine Peterson
• Johnathon Dahlin Peterson, LCMHC, LPC
• Matthew Wade Peterson, D.C.

• Dentist in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; 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.