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General NPI Number Information
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NPI Number | 1881703700
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Entity Type | Individual
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Provider Name | JOHN CONRAD PETERSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 2983 LONG BEACH RD
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City | OCEANSIDE
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State | NY
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Zip | 11572-3204
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Country | US
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Telephone | 516-536-5777
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Fax | 855-201-3647
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Provider Business Mailing Address
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Address Line | 2983 LONG BEACH RD
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City | OCEANSIDE
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State | NY
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Zip | 11572-3204
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Country | US
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Telephone | 516-536-5777
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Fax | 516-536-5919
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 029836-1
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License Number State | NY
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