Search › Alaska › 122300000X
Grant Petersen, D.D.S
NPI 1790031128 · on the registry since 2012 · sole proprietor
Practice
- Address
- 1060 Gaffney Rd Stop 7500
Fort Wainwright, AK 99703 - Phone
- (907) 353-5530
- Fax
- (317) 361-5530
- Organisation at this address
- Bassett Army Community Hospital
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 4
Registry record
- Primary taxonomy
- 122300000X
122300000X
- Licence states on file
- CO
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2013-07-16
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Alaska