Provider Demographics
NPI:1548432867
Name:ALFRED B. PETERS, D.M.D., P.C.
Entity Type:Organization
Organization Name:ALFRED B. PETERS, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:B
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:D,MD
Authorized Official - Phone:478-453-8464
Mailing Address - Street 1:540 W THOMAS ST
Mailing Address - Street 2:STE. A
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2743
Mailing Address - Country:US
Mailing Address - Phone:478-453-8464
Mailing Address - Fax:478-414-1215
Practice Address - Street 1:540 W THOMAS ST
Practice Address - Street 2:STE. A
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2743
Practice Address - Country:US
Practice Address - Phone:478-453-8464
Practice Address - Fax:478-414-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty