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General NPI Number Information
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NPI Number | 1225364789
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Entity Type | Individual
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Provider Name | EMILY WILEY PETERS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 138 CHURCH ST
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City | ALEXANDRIA BAY
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State | NY
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Zip | 13607-1703
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Country | US
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Telephone | 315-482-9941
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Fax | 315-482-2783
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Provider Business Mailing Address
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Address Line | 138 CHURCH ST P.O. BOX 8
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City | ALEXANDRIA BAY
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State | NY
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Zip | 13607-1703
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Country | US
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Telephone | 315-482-9941
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Fax | 315-482-2783
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 054697
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 054697
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License Number State | NY
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