Provider Demographics
NPI:1205398567
Name:PETERS, DAKANDRYIA (DDS)
Entity Type:Individual
Prefix:
First Name:DAKANDRYIA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 S ISABELLA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-5531
Mailing Address - Country:US
Mailing Address - Phone:619-847-1054
Mailing Address - Fax:
Practice Address - Street 1:2019 N RIVERSIDE AVE # C
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4657
Practice Address - Country:US
Practice Address - Phone:909-877-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice