Provider Demographics
NPI:1255709697
Name:MARY KATE PETERS, DDS, PLLC
Entity type:Organization
Organization Name:MARY KATE PETERS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHARINE
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-478-4411
Mailing Address - Street 1:507 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1511
Mailing Address - Country:US
Mailing Address - Phone:512-478-4411
Mailing Address - Fax:512-478-0069
Practice Address - Street 1:507 W 15TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1511
Practice Address - Country:US
Practice Address - Phone:512-478-4411
Practice Address - Fax:512-478-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty