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Individual

BRIDGET LEIGH PETERSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
11535 MAIN RD, MATTITUCK, NY 11952-1566
(631) 298-5021
Mailing address
PO BOX 1650, MATTITUCK, NY 11952-0904
(631) 298-5021

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
058009
NY

Other

Enumeration date
04/18/2014
Last updated
12/03/2015
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