Provider Demographics
NPI:1033316906
Name:PETERS, DWIGHT PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:PATRICK
Last Name:PETERS
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 1:1006 LEAWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-3349
Mailing Address - Country:US
Mailing Address - Phone:502-223-0211
Mailing Address - Fax:502-875-5567
Practice Address - Street 1:1006 LEAWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3349
Practice Address - Country:US
Practice Address - Phone:502-223-0211
Practice Address - Fax:502-875-5567
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist