Provider Demographics
NPI:1114040938
Name:PETERS, OBADIAH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:OBADIAH
Middle Name:J
Last Name:PETERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 DONNELL DR
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3971
Mailing Address - Country:US
Mailing Address - Phone:301-736-4542
Mailing Address - Fax:301-316-1237
Practice Address - Street 1:4400 STAMP RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6716
Practice Address - Country:US
Practice Address - Phone:301-316-1236
Practice Address - Fax:301-316-1237
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD58281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice