Provider Demographics
NPI:1861693806
Name:PETERS, SHELLI RAE (DDS)
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:RAE
Last Name:PETERS
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 1:18700 W LAKE HOUSTON PKWY
Mailing Address - Street 2:#A107
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3349
Mailing Address - Country:US
Mailing Address - Phone:281-964-1001
Mailing Address - Fax:281-852-6770
Practice Address - Street 1:18700 W LAKE HOUSTON PKWY
Practice Address - Street 2:#A107
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3349
Practice Address - Country:US
Practice Address - Phone:281-964-1001
Practice Address - Fax:281-852-6770
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist