Healthcare Provider Details

I. General information

NPI: 1841384476
Provider Name (Legal Business Name): PETER PETERSON & JESSE SORRENTINO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 FARMINGTON AVE
FARMINGTON CT
06032
US

IV. Provider business mailing address

291 FARMINGTON AVE
FARMINGTON CT
06032
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-8747
  • Fax: 860-674-9670
Mailing address:
  • Phone: 860-677-8747
  • Fax: 860-674-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER J.M. PETERSON
Title or Position: PARTNER
Credential: D.M.D.
Phone: 860-677-8747