1215149596 NPI number — PETER PETERSON & JESSE SORRENTINO P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215149596 NPI number — PETER PETERSON & JESSE SORRENTINO P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER PETERSON & JESSE SORRENTINO P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOHN BIERLY DMD AND PETER J PETERSON DMD PC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215149596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 FARMINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06032-1925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-677-8747
Provider Business Mailing Address Fax Number:
860-674-9670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 FARMINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06032-1925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-677-8747
Provider Business Practice Location Address Fax Number:
860-674-9670
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SORRENTINO
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
860-677-8747

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  7255 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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