# THEODORE EDWARD DAVID PETERS, DDS,PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255501342
- **Authorized official:** DR. THEODORE EDWARD DAVID PETERS DDS (SURGEON)
- **Authorized official phone:** (813) 870-1220

## Contact information

- **Practice address:** 508 S HABANA AVE, SUITE 110, TAMPA, FL 33609-4181
- **Practice address phone:** (813) 870-1220
- **Practice address fax:** (813) 870-2615
- **Mailing address:** 508 S HABANA AVE, SUITE 110, TAMPA, FL 33609-4181
- **Mailing address phone:** (813) 870-1220
- **Mailing address fax:** (813) 870-2615

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 13473 | FL | Yes |

## Other

- **Enumeration date:** 03/05/2008
- **Last updated:** 03/05/2008