Healthcare Provider Details

I. General information

NPI: 1336113562
Provider Name (Legal Business Name): BARBARA PETERSON JR. DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 UTICA AVE
BROOKLYN NY
11203-3411
US

IV. Provider business mailing address

894 LAFAYETTE AVE
BROOKLYN NY
11221-5947
US

V. Phone/Fax

Practice location:
  • Phone: 718-922-2800
  • Fax:
Mailing address:
  • Phone: 917-648-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number051248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: