Provider Demographics
NPI:1336113562
Name:PETERSON, BARBARA JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:PETERSON
Suffix:JR
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5947
Mailing Address - Country:US
Mailing Address - Phone:917-648-0012
Mailing Address - Fax:
Practice Address - Street 1:763 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3411
Practice Address - Country:US
Practice Address - Phone:718-922-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0512481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics