Provider Demographics
NPI:1538137591
Name:PETERS, MARY KATHARINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHARINE
Last Name:PETERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:KATHARINE
Other - Last Name:SAVITSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3204 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1445
Mailing Address - Country:US
Mailing Address - Phone:512-494-5436
Mailing Address - Fax:
Practice Address - Street 1:3204 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1445
Practice Address - Country:US
Practice Address - Phone:512-494-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice