Individual
DR. PETA KATHEE DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
325 HOSPITAL DR STE 101, GLEN BURNIE, MD 21061-5806
(914) 222-3489
Mailing address
1775 GRAND CONCOURSE, 6TH FLOOR, BRONX, NY 10453-8202
(718) 901-8110
(718) 901-8162
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17268
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2017
Last updated
04/25/2022
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