Provider Demographics
NPI:1588857163
Name:PETERMAN, JOHN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:PETERMAN
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 1:90 ROUTE 6A, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563
Mailing Address - Country:US
Mailing Address - Phone:508-888-4001
Mailing Address - Fax:508-888-9184
Practice Address - Street 1:90 ROUTE 6A, SUITE 2
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:508-888-4001
Practice Address - Fax:508-888-9184
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice