Provider Demographics
NPI:1528124351
Name:PETERS, STEVEN D (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:PETERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 NE LOOP 286
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5000
Mailing Address - Country:US
Mailing Address - Phone:903-785-2541
Mailing Address - Fax:903-785-2045
Practice Address - Street 1:3605 NE LOOP 286
Practice Address - Street 2:SUITE 1200
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5000
Practice Address - Country:US
Practice Address - Phone:903-785-2541
Practice Address - Fax:903-785-2045
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD152011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU02657Medicare UPIN
TXD15201Medicare ID - Type Unspecified