MEDICARE: TIMOTHY W. PETERS DDS & ERICH D. LENZ DDS INC

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

General Provider Information

NPI Number	:	1114140746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY W. PETERS DDS & ERICH D. LENZ DDS INC

Provider Business Mailing Address
First Line	:	7465 DEER RUN LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45233-4212
Country	:	US
Telephone Number	:	513-941-4666
Fax Number	:	513-598-1700

Provider Business Practice Location Address
First Line	:	6431 BRIDGETOWN RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-2934
Country	:	US
Telephone Number	:	513-574-1477
Fax Number	:	513-598-1700

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DEE G. PETERS
Credential	:
Telephone Number	:	513-941-4666

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	06/17/2008

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