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General NPI Number Information
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NPI Number | 1306560362
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Entity Type | Individual
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Provider Name | CRYSTAL RENEE' PETERS DDS
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 2604 ALDRICH ST STE A
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City | AUSTIN
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State | TX
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Zip | 78723-3484
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Country | US
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Telephone | 512-843-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 25120 PANTHER BEND CT APT 213
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City | SPRING
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State | TX
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Zip | 77380-4196
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Country | US
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Telephone | 317-989-2392
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 39030
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License Number State | TX
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