Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 054697 | NY |
N | 1223D0001X | Dental Public Health | 054697 | NY |
NPI | 1225364789 |
---|---|
Provider Name | Dr. Emily Wiley Peters |
First Address | Alexandria Bay, NY 13607-1703 |
Second Address | Alexandria Bay, NY 13607-1703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2009 |
Last Update Date | 23/03/2012 |