BYRON THAD PETERSEN DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019015628

License Status

INACTIVE

Business

First Name

BYRON THAD

Last Name

PETERSEN

Suffix

DDS

Business Name

BYRON THAD PETERSEN DDS

Original Issue Date

07/13/1976

Effective Date

07/13/1976

Expiration Date

09/30/1996

City

SALT LAKE CITY

State

Zip

84148

County

UTAH

Ever Disciplined

LastModifiedDate

10/12/2005