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General NPI Number Information
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NPI Number | 1457058356
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Entity Type | Individual
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Provider Name | KRISTY PETERS RDH
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Gender | Female
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 6027 PETERS CREEK RD
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City | ROANOKE
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State | VA
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Zip | 24019-4029
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Country | US
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Telephone | 540-366-5373
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Fax |
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Provider Business Mailing Address
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Address Line | 208 DEER TRAK
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City | CLOVERDALE
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State | VA
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Zip | 24077-3059
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Country | US
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Telephone | 540-892-6336
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0402004698
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License Number State | VA
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