Byron Thad Petersen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

135438-9923 Issued in UT

Practice address

George E Wahlen Dept of Veterans Affairs Medical Ctr
500 Foothill Drive, Dental Service (160)
Salt Lake City, UT 84148-0001

Phone

(801) 584-1206

Fax

(801) 584-1251

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477566198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2162 E. CREEK ROAD",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840936448",
            "telephone_number": "801-942-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GEORGE E WAHLEN DEPT OF VETERANS AFFAIRS MEDICAL CTR",
            "address_2": "500 FOOTHILL DRIVE, DENTAL SERVICE (160)",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841480001",
            "telephone_number": "801-584-1206",
            "fax_number": "801-584-1251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "BYRON",
        "middle_name": "THAD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "135438-9923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Petersen, LCSW
• Anthony Michael Petersen, M.D.
• Brett Petersen
• Brian Lamar Petersen, LCSW
• Brittany J Petersen, LMFT, LPC, CMHC
• Casey Brian Petersen, LCSW
• Catherine Adriana Petersen
• Chrissa Petersen
• David B Petersen, MD
• Elaine Petersen, OTR/L

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.