Provider Demographics
NPI:1215149596
Name:PETER PETERSON & JESSE SORRENTINO P.C.
Entity type:Organization
Organization Name:PETER PETERSON & JESSE SORRENTINO P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-677-8747
Mailing Address - Street 1:291 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1925
Mailing Address - Country:US
Mailing Address - Phone:860-677-8747
Mailing Address - Fax:860-674-9670
Practice Address - Street 1:291 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1925
Practice Address - Country:US
Practice Address - Phone:860-677-8747
Practice Address - Fax:860-674-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty