Provider Demographics
NPI:1770030199
Name:PETERS, BRANDON (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
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:DEPARTMENT OF PROSTHODONTICS UNC SCHOOL OF DENTISTRY
Mailing Address - Street 2:CAMPUS BOX #7450
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-537-3947
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PROSTHODONTICS UNC SCHOOL OF DENTISTRY
Practice Address - Street 2:CAMPUS BOX #7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-537-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC151101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist