Provider Demographics
NPI:1609360478
Name:WILSON, PETER JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:WILSON
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PORTLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-6508
Mailing Address - Country:US
Mailing Address - Phone:330-780-9747
Mailing Address - Fax:
Practice Address - Street 1:1 INN ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2557
Practice Address - Country:US
Practice Address - Phone:978-992-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04422122300000X
MADN1858772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist