Healthcare Provider Details

I. General information

NPI: 1548207517
Provider Name (Legal Business Name): FRANK V PETERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32020 LITTLE BOSTON RD NE
KINGSTON WA
98346-9734
US

IV. Provider business mailing address

9060 SILVERDALE WAY NW
SILVERDALE WA
98383-9198
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-9649
  • Fax:
Mailing address:
  • Phone: 360-692-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4123
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: