MEDICARE: DR. ANDREA MARIE PETERS D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D12702	MN

General Provider Information

NPI Number	:	1154557932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA MARIE PETERS D.D.S

Provider Business Mailing Address
First Line	:	931 WHITEWATER AVE
Second Line	:
City	:	SAINT CHARLES
State	:	MN
Zip	:	55972-1130
Country	:	US
Telephone Number	:	507-932-4530
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 WHITEWATER AVE
Second Line	:
City	:	SAINT CHARLES
State	:	MN
Zip	:	55972-1130
Country	:	US
Telephone Number	:	507-932-4530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2009
Last Update Date	:	06/07/2009

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