Provider Demographics
NPI:1952517328
Name:DOTSON, PETER HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:HENRY
Last Name:DOTSON
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 1:411 NICHOLS RD
Mailing Address - Street 2:STE 257
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2000
Mailing Address - Country:US
Mailing Address - Phone:816-931-3636
Mailing Address - Fax:816-931-0557
Practice Address - Street 1:411 NICHOLS RD
Practice Address - Street 2:STE 257
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2000
Practice Address - Country:US
Practice Address - Phone:816-931-3636
Practice Address - Fax:816-931-0557
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO012075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist