Provider Demographics
NPI:1548560816
Name:GREGORY S PETERSON DMD & ASSOCIATES
Entity Type:Organization
Organization Name:GREGORY S PETERSON DMD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-833-3944
Mailing Address - Street 1:1725 WASHINGTON RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1207
Mailing Address - Country:US
Mailing Address - Phone:412-833-3944
Mailing Address - Fax:412-833-4347
Practice Address - Street 1:1725 WASHINGTON RD
Practice Address - Street 2:SUITE 600
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1207
Practice Address - Country:US
Practice Address - Phone:412-833-3944
Practice Address - Fax:412-833-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025423-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty