Provider Demographics
NPI:1750341350
Name:PETERS, FREDERICK K (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:K
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 1:309 S CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-1612
Mailing Address - Country:US
Mailing Address - Phone:330-875-2200
Mailing Address - Fax:330-875-2403
Practice Address - Street 1:309 S CHAPEL ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1612
Practice Address - Country:US
Practice Address - Phone:330-875-2200
Practice Address - Fax:330-875-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice