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General NPI Number Information
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NPI Number | 1669614772
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Entity Type | Organization
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Legal Business Name | JOHN A. BIERLY DMD AND PETER J. PETERSON DMD, PC
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Dates
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Enumeration Date | 04/03/2009
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Last Update Date | 04/03/2009
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Provider Practice Location Address
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Address Line | 20 W AVON RD
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City | AVON
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State | CT
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Zip | 06001-3677
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Country | US
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Telephone | 860-404-0233
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Fax |
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Provider Business Mailing Address
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Address Line | 20 W AVON RD
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City | AVON
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State | CT
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Zip | 06001-3677
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Country | US
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Telephone | 860-404-0233
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | PETER PETERSON
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Credential |
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Telephone | 860-677-8747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 7255
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License Number State | CT
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