Provider Demographics
NPI:1639488463
Name:KAUFMAN, PETER JEFF (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JEFF
Last Name:KAUFMAN
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 1:3900 CLARK RD
Mailing Address - Street 2:BUILDING I
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2301
Mailing Address - Country:US
Mailing Address - Phone:941-922-3524
Mailing Address - Fax:941-924-2929
Practice Address - Street 1:3900 CLARK RD
Practice Address - Street 2:BUILDING I
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2301
Practice Address - Country:US
Practice Address - Phone:941-922-3524
Practice Address - Fax:941-924-2929
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN99441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN9944OtherDENTAL LISCENSE