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General NPI Number Information
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NPI Number | 1992996946
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Entity Type | Individual
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Provider Name | KATHERINE R. PETERSEN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 10230 BERKELEY PLACE DR STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28262-1203
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Country | US
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Telephone | 704-688-7588
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Fax |
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Provider Business Mailing Address
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Address Line | 133 CREEK SIDE DR
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City | MOUNT HOLLY
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State | NC
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Zip | 28120-9247
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Country | US
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Telephone | 704-577-2798
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10553
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License Number State | NC
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