MEDICARE: DR. BARBARA PETERSON JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	051248	NY

General Provider Information

NPI Number	:	1336113562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA PETERSON JR. DDS

Provider Business Mailing Address
First Line	:	894 LAFAYETTE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-5947
Country	:	US
Telephone Number	:	917-648-0012
Fax Number	:

Provider Business Practice Location Address
First Line	:	763 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3411
Country	:	US
Telephone Number	:	718-922-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	01/02/2013

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