NPI 1003813445

Douglas E Peterson, DMD

Practitioner Dentist Farmington, CT

Practice location

Address: 263 Farmington Ave, Farmington, CT 06030-0001
Phone: (860) 679-2952
Fax: (860) 679-4760
Mailing address: 263 Farmington Ave Provider Enrollment, Farmington, CT 06030-2212

Registered specialties (2)

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 007480 (CT)

Other Dentist providers in Connecticut →

General Practice Dentistry

Dental Providers Taxonomy 1223G0001X Licence 007480 (CT)

Registry record

NPI: 1003813445
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Jun 2005
Record last updated: 12 May 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.