Provider Demographics
NPI:1265711329
Name:PETERS, BARRETT W R (DDS MSD)
Entity type:Individual
Prefix:
First Name:BARRETT
Middle Name:W R
Last Name:PETERS
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 HYDRAULIC RIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8130
Mailing Address - Country:US
Mailing Address - Phone:434-973-4344
Mailing Address - Fax:434-973-4675
Practice Address - Street 1:240 HYDRAULIC RIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8130
Practice Address - Country:US
Practice Address - Phone:434-973-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014132041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry