Provider Demographics
NPI:1154557932
Name:PETERS, ANDREA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 WHITEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MN
Mailing Address - Zip Code:55972-1130
Mailing Address - Country:US
Mailing Address - Phone:507-932-4530
Mailing Address - Fax:
Practice Address - Street 1:931 WHITEWATER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MN
Practice Address - Zip Code:55972-1130
Practice Address - Country:US
Practice Address - Phone:507-932-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice