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General NPI Number Information
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NPI Number | 1255709697
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Entity Type | Organization
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Legal Business Name | MARY KATE PETERS, DDS, PLLC
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 507 W 15TH ST
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City | AUSTIN
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State | TX
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Zip | 78701-1511
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Country | US
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Telephone | 512-478-4411
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Fax | 512-478-0069
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Provider Business Mailing Address
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Address Line | 507 W 15TH ST
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City | AUSTIN
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State | TX
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Zip | 78701-1511
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Country | US
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Telephone | 512-478-4411
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Fax | 512-478-0069
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MARY KATHARINE PETERS
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Credential | DDS
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Telephone | 512-478-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22337
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License Number State | TX
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