Most Relevant Information
Provider Data
| NPI Number: | 1003498825 |
| Provider Name: | DANIEL BRYCE PETERSEN |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 10414 |
Most Important Dates
| Enumeration Date: | 04/21/2021 |
| Last Updated: | 08/23/2024 |
Provider Practice Location
420 POLIFKA DR BLDG 1042
SHAW AFB
SC
291525100
Practice Location Phone/Fax
| Phone: | 8038956951 |
| Fax: |
Provider Mailing Location
420 POLIFKA DR BLDG 1042
SHAW AFB
SC
291525100
Provider Mailing Phone/Fax
| Phone: | 8036956988 |
| Fax: |