Provider Demographics
NPI:1073680013
Name:PETERS, THOMAS G (DR DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:PETERS
Suffix:
Gender:M
Credentials:DR DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:SUITE 329
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1909
Mailing Address - Country:US
Mailing Address - Phone:860-677-8500
Mailing Address - Fax:860-677-4113
Practice Address - Street 1:270 FARMINGTON AVE
Practice Address - Street 2:SUITE 329
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1909
Practice Address - Country:US
Practice Address - Phone:860-677-8500
Practice Address - Fax:860-677-4113
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT7299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist