MEDICARE: DR. OBADIAH J PETERS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5828	MD

General Provider Information

NPI Number	:	1114040938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OBADIAH J PETERS D.D.S.

Provider Business Mailing Address
First Line	:	3913 DONNELL DR
Second Line	:
City	:	FORESTVILLE
State	:	MD
Zip	:	20747-3971
Country	:	US
Telephone Number	:	301-736-4542
Fax Number	:	301-316-1237

Provider Business Practice Location Address
First Line	:	4400 STAMP RD
Second Line	:	SUITE 202
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6716
Country	:	US
Telephone Number	:	301-316-1236
Fax Number	:	301-316-1237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2007
Last Update Date	:	07/08/2007

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