=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922016922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER T CRESSMAN DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 1/2 SPRING LANE
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-746-1128
-----------------------------------------------------
Fax | 508-747-3074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 1/2 SPRING LANE
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-746-1128
-----------------------------------------------------
Fax | 508-747-3074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF PROFESSIONAL CORP ORTH
-----------------------------------------------------
Name | DR. PETER TOMPKINS CRESSMAN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 508-746-1128
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 11638
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------