Provider Demographics
NPI:1902018799
Name:BREEN, PETER E (DMD,)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:BREEN
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 1:292 MAIN ST.
Mailing Address - Street 2:P.O. BOX 1039
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1236
Mailing Address - Country:US
Mailing Address - Phone:978-448-5241
Mailing Address - Fax:
Practice Address - Street 1:292 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1236
Practice Address - Country:US
Practice Address - Phone:978-448-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice