MEDICARE: DR. PETER CHIEM D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4935	NV
2	122300000X	Dentist	47461	CA

General Provider Information

NPI Number	:	1285793182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER CHIEM D.D.S

Provider Business Mailing Address
First Line	:	7910 S RAINBOW BLVD
Second Line	:	STE 125
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6478
Country	:	US
Telephone Number	:	702-457-7858
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 S RAINBOW BLVD
Second Line	:	SUITE 125
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6478
Country	:	US
Telephone Number	:	702-457-7858
Fax Number	:	702-457-7828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	09/29/2020

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