Petersen, Chad William

Petersen, Chad William is an individual health care provider with primary practice located at 6238 Yellowstone Rd , Cheyenne WY 82009-3432. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Petersen, Chad William can be contacted via phone (307) 635-6940.

Contact Information

Primary practice address
6238 Yellowstone Rd Cheyenne WY 82009-3432
Phone: (307) 635-6940
Fax: (307) 635-2839
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 1436 Wyoming

Profile Details

NPI number 1336582212
LBN Legal business name Petersen, Chad William
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2013
Last updated Dec 12th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336582212 NPPES
Wyoming MEDICAID 145967800

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