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NPI Code Detail

MEDICARE: DR. LISA M PETERS DMD

MEDICARE: DR. LISA M PETERS DMD
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
11223G0001XGeneral Practice Dentistry14918FL

General Provider Information

NPI Number : 1881714293
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA M PETERS DMD
Provider Business Mailing Address
First Line : 7521 W SAND LAKE RD
Second Line :
City : ORLANDO
State : FL
Zip : 32819-5109
Country : US
Telephone Number : 407-354-0044
Fax Number : 407-354-0003
Provider Business Practice Location Address
First Line : 7521 W SAND LAKE RD
Second Line :
City : ORLANDO
State : FL
Zip : 32819-5109
Country : US
Telephone Number : 407-354-0044
Fax Number : 407-354-0003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 07/08/2007

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