Provider Demographics
NPI:1912062696
Name:TIAN, PETER ZHIMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ZHIMIN
Last Name:TIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ZHIMIN
Other - Middle Name:
Other - Last Name:TIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:842 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3004
Mailing Address - Country:US
Mailing Address - Phone:617-864-1600
Mailing Address - Fax:617-864-6030
Practice Address - Street 1:842 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3004
Practice Address - Country:US
Practice Address - Phone:617-864-1600
Practice Address - Fax:617-864-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice