Provider Demographics
NPI:1679922496
Name:PETERS, KAREN (RDH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RICHARDSON DR
Mailing Address - Street 2:BLD. # 634
Mailing Address - City:FORT RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99505-8310
Mailing Address - Country:US
Mailing Address - Phone:907-384-2483
Mailing Address - Fax:
Practice Address - Street 1:600 RICHARDSON DR
Practice Address - Street 2:BLD. # 634
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-8310
Practice Address - Country:US
Practice Address - Phone:907-384-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK413124Q00000X
AK458124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK458OtherSTATE OF AK LOCAL ANESTHETIC LICENSE
AK413OtherSTATE OF AK DENTAL HYGIENE LICENSE