Provider Demographics
NPI:1073749875
Name:PETERSEN, LORNA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:L
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 N 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944
Mailing Address - Country:US
Mailing Address - Phone:215-257-5095
Mailing Address - Fax:215-257-3941
Practice Address - Street 1:1316 N 5TH STREET
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944
Practice Address - Country:US
Practice Address - Phone:215-257-5095
Practice Address - Fax:215-257-3941
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS26167L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist