Provider Demographics
NPI:1639199714
Name:SCHORTMANN, PETER MATTHEW (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MATTHEW
Last Name:SCHORTMANN
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 1:349 AUTUMN AVE
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4614
Mailing Address - Country:US
Mailing Address - Phone:781-585-1970
Mailing Address - Fax:
Practice Address - Street 1:331 COTUIT RD
Practice Address - Street 2:SUITE 30
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2428
Practice Address - Country:US
Practice Address - Phone:508-888-1040
Practice Address - Fax:508-888-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0262684Medicaid