Provider Demographics
NPI:1578567228
Name:AUDETTE, PETER P (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:P
Last Name:AUDETTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PARK AVE
Mailing Address - Street 2:STE 800
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1984
Mailing Address - Country:US
Mailing Address - Phone:508-753-3200
Mailing Address - Fax:508-753-1894
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:STE 800
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1984
Practice Address - Country:US
Practice Address - Phone:508-753-3200
Practice Address - Fax:508-753-1894
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice