Provider Demographics
NPI:1164546859
Name:M H PETERS JR DDS INC
Entity Type:Organization
Organization Name:M H PETERS JR DDS INC
Other - Org Name:PETERS DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANFED
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-486-8061
Mailing Address - Street 1:2508 BAY AREA BLVD. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058
Mailing Address - Country:US
Mailing Address - Phone:281-486-8061
Mailing Address - Fax:
Practice Address - Street 1:2508 BAY AREA BLVD. SUITE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-486-8061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89D682OtherBCBS OF TEXAS
TXB10881-01OtherTEXAS CHIPS PROGRAM