Provider Demographics
NPI:1689789364
Name:PETERSON, DONALD W JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:PETERSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:26615 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1968
Mailing Address - Country:US
Mailing Address - Phone:281-296-8600
Mailing Address - Fax:281-296-9509
Practice Address - Street 1:3648 FM 1960 RD W
Practice Address - Street 2:SUITE 112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3617
Practice Address - Country:US
Practice Address - Phone:281-586-9400
Practice Address - Fax:281-537-2255
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX133771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice