Provider Demographics
NPI:1316476351
Name:MAILHOT, PETER CHRISTIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:CHRISTIAN
Last Name:MAILHOT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 BABCOCK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2345
Mailing Address - Country:US
Mailing Address - Phone:210-904-2888
Mailing Address - Fax:
Practice Address - Street 1:6565 BABCOCK RD STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2345
Practice Address - Country:US
Practice Address - Phone:210-904-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0413021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice