Healthcare Provider Details

I. General information

NPI: 1811801541
Provider Name (Legal Business Name): BRIAN PETERS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 W ADMIRAL TAUSSIG BLVD
FPO AA
23511
US

IV. Provider business mailing address

1647 W ADMIRAL TAUSSIG BLVD
FPO AA
23511
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-8635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037131
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: