Provider Demographics
NPI:1972836807
Name:PETERS, BREYN R (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:BREYN
Middle Name:R
Last Name:PETERS
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 LINCOLN AVE E
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 COMMERCE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4060
Practice Address - Country:US
Practice Address - Phone:973-639-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0543751223X0400X
NJ22DJ024056001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics