Provider Demographics
NPI:1609088145
Name:PETERS, CHARLES BARNETT III (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BARNETT
Last Name:PETERS
Suffix:III
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16011 HUEBNER CRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1471
Mailing Address - Country:US
Mailing Address - Phone:210-857-1383
Mailing Address - Fax:
Practice Address - Street 1:933 FM 3009
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1000
Practice Address - Country:US
Practice Address - Phone:210-659-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics