Healthcare Provider Details

I. General information

NPI: 1558347435
Provider Name (Legal Business Name): PETER BARNDT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 06/03/2021
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NAVAL HOSPITAL YOKOSUKA
FPO AP
96350
US

IV. Provider business mailing address

7 MAYWOOD DR
OLD LYME CT
06371-1544
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-3500
  • Fax:
Mailing address:
  • Phone: 843-986-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5315024593
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: