Provider Demographics
NPI:1619171352
Name:PETERS, JAMES LANCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LANCE
Last Name:PETERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S CEDAR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1589
Mailing Address - Country:US
Mailing Address - Phone:517-676-3770
Mailing Address - Fax:517-676-3771
Practice Address - Street 1:624 S CEDAR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1589
Practice Address - Country:US
Practice Address - Phone:517-676-3770
Practice Address - Fax:517-676-3771
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist