Provider Demographics
NPI:1932417110
Name:BRZOZA, PETER PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PAUL
Last Name:BRZOZA
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 1:1 ROOSEVELT AVE
Mailing Address - Street 2:203
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-854-5666
Mailing Address - Fax:
Practice Address - Street 1:1 ROOSEVELT AVE
Practice Address - Street 2:203
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2904
Practice Address - Country:US
Practice Address - Phone:978-854-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist