Provider Demographics
NPI:1629296652
Name:MORTON, PETER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MORTON
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 1:1150 HAMMOND DR NE
Mailing Address - Street 2:BUILDING E, SUITE 225
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5334
Mailing Address - Country:US
Mailing Address - Phone:770-913-0703
Mailing Address - Fax:
Practice Address - Street 1:1150 HAMMOND DR NE
Practice Address - Street 2:BUILDING E, SUITE 225
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5334
Practice Address - Country:US
Practice Address - Phone:770-913-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice