Provider Demographics
NPI:1912016866
Name:PETERS, RICHARD C (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
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:PO BOX 710
Mailing Address - Street 2:199HWY 50
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552-0710
Mailing Address - Country:US
Mailing Address - Phone:505-757-6666
Mailing Address - Fax:505-757-2700
Practice Address - Street 1:199 HWY 50
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552-0710
Practice Address - Country:US
Practice Address - Phone:505-757-6666
Practice Address - Fax:505-757-2700
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice