Individual
JOHN CONRAD PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2983 LONG BEACH RD, OCEANSIDE, NY 11572-3204
(516) 536-5777
(855) 201-3647
Mailing address
2983 LONG BEACH RD, OCEANSIDE, NY 11572-3204
(516) 536-5777
(516) 536-5919
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
029836-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00304132
—
NY
Enumeration date
08/30/2006
Last updated
02/18/2026
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