Provider Demographics
NPI:1467473389
Name:COTSONAS, PETER EUSTACE (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:EUSTACE
Last Name:COTSONAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1527
Mailing Address - Country:US
Mailing Address - Phone:781-335-5420
Mailing Address - Fax:781-335-1876
Practice Address - Street 1:884 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-1527
Practice Address - Country:US
Practice Address - Phone:781-335-5420
Practice Address - Fax:781-335-1876
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics