Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr Tyson Peteresn

Organization Dental Clinic/Center · NPI 1972121770

Dr Tyson Peteresn is a Dental Clinic/Center in Logan, Utah. Registered with an NPI since 2020.

In the registry since
2020

Practice location Address checks out

110 E 200 N
Logan, UT 84321-4007
Phone: (435) 752-0300
Fax: (435) 755-7625
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X

Record details

NPI number1972121770
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tyson Petersen — Dr · (435) 752-0300
NPI enumeratedJuly 8, 2020
Last updated in NPPESJuly 8, 2020
Certification dateJuly 8, 2020
Mailing address110 E 200 N, Logan, UT 84321-4007

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