Individual
BETHANY ANNE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4410 E RIVERSIDE DR STE 150, AUSTIN, TX 78741-4759
(855) 512-7625
Mailing address
1620 E RIVERSIDE DR APT 4034, AUSTIN, TX 78741-1026
(713) 492-7719
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
28004
TX
Other
Enumeration date
06/29/2012
Last updated
06/29/2012
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