Provider Demographics
NPI:1427151786
Name:PETERSON, BARRY E (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 WOOD RD BLDG 14TH
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5611
Mailing Address - Country:US
Mailing Address - Phone:301-295-0064
Mailing Address - Fax:
Practice Address - Street 1:8955 WOOD RD BLDG 14TH
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5628
Practice Address - Country:US
Practice Address - Phone:301-295-0064
Practice Address - Fax:301-295-5767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist