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General NPI Number Information
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NPI Number | 1154637825
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Entity Type | Organization
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Legal Business Name | GRANGER PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | GRANGER PEDIATRIC DENTISTRY 3535 S MARKET STREET SUITE #145
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3637
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Country | US
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Telephone | 801-969-8881
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Fax | 801-969-8889
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Provider Business Mailing Address
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Address Line | GRANGER PEDIATRIC DENTISTRY P.O. BOX 18430
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City | SALT LAKE CITY
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State | UT
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Zip | 84118-0430
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Country | US
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Telephone | 801-969-8881
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Fax | 801-969-8889
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. HANS C PETERSEN
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Credential | DMD
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Telephone | 801-969-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 360305-9923
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License Number State | UT
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