MEDICARE: DR. PETER PETROU DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN1858091	MA

General Provider Information

NPI Number	:	1649756958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER PETROU DMD

Provider Business Mailing Address
First Line	:	1330 BOYLSTON ST UNIT 812
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-5524
Country	:	US
Telephone Number	:	331-218-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	438 WASHINGTON ST UNIT 1
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-2966
Country	:	US
Telephone Number	:	617-782-2267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	12/31/2025

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