Provider Demographics
NPI:1073556726
Name:DORSEY, PETER J (D D S)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:DORSEY
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-2127
Mailing Address - Country:US
Mailing Address - Phone:337-478-2014
Mailing Address - Fax:337-480-1846
Practice Address - Street 1:3447 5TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2127
Practice Address - Country:US
Practice Address - Phone:337-478-2014
Practice Address - Fax:337-480-1846
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice