Provider Demographics
NPI:1760553937
Name:PETERSON, HELEN KATIE (DDS)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:KATIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 E WASHINGTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-6616
Mailing Address - Country:US
Mailing Address - Phone:317-322-1840
Mailing Address - Fax:
Practice Address - Street 1:2802 LAFAYETTE RD STE 33
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-2112
Practice Address - Country:US
Practice Address - Phone:317-925-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010757A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200532910Medicaid