Healthcare Provider Details

I. General information

NPI: 1013986066
Provider Name (Legal Business Name): LERNER & PETERSEN, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 NEWTON ST
SOUTH HADLEY MA
01075-2331
US

IV. Provider business mailing address

446 NEWTON ST
SOUTH HADLEY MA
01075-2331
US

V. Phone/Fax

Practice location:
  • Phone: 413-536-4730
  • Fax:
Mailing address:
  • Phone: 413-536-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14425
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15449
License Number StateMA

VIII. Authorized Official

Name: DR. HOWARD G. LERNER
Title or Position: PARTNER
Credential: DDS
Phone: 413-536-4730