Most Relevant Information
Provider Data
| NPI Number: | 1003813445 |
| Provider Name: | DOUGLAS E PETERSON DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 007480 |
Most Important Dates
| Enumeration Date: | 06/30/2005 |
| Last Updated: | 05/12/2021 |
Provider Practice Location
263 FARMINGTON AVE
FARMINGTON
CT
060300001
Practice Location Phone/Fax
| Phone: | 8606792952 |
| Fax: | 8606794760 |
Provider Mailing Location
263 FARMINGTON AVE
PROVIDER ENROLLMENT
FARMINGTON
CT
060302212
Provider Mailing Phone/Fax
| Phone: | 8606797503 |
| Fax: | 8606791610 |