Provider Demographics
NPI:1992996946
Name:PETERSEN, KATHERINE R (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:R
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:RHYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:133 CREEK SIDE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9247
Mailing Address - Country:US
Mailing Address - Phone:704-577-2798
Mailing Address - Fax:
Practice Address - Street 1:10230 BERKELEY PLACE DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1203
Practice Address - Country:US
Practice Address - Phone:704-688-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist