NPI 1003170531

Bethany Anne Petersen, DDS

Practitioner Dentist Austin, TX

Practice location

Address: 4410 E Riverside Dr STE 150, Austin, TX 78741-4759
Phone: (855) 512-7625
Mailing address: 1620 E Riverside Dr APT 4034, Austin, TX 78741-1026

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 28004 (TX)

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Registry record

NPI: 1003170531
Entity type: Individual
Sex (as registered): Female
NPI issued: 29 Jun 2012
Record last updated: 29 Jun 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.