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NPI Code Detail

MEDICARE: DR. PETER MICHAEL BLOUGH DDS

MEDICARE: DR. PETER MICHAEL BLOUGH DDS
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
1122300000XDentistDDS-09131IA
2122300000XDentist7114-15WI

General Provider Information

NPI Number : 1487093258
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER MICHAEL BLOUGH DDS
Provider Business Mailing Address
First Line : 1111 9TH ST
Second Line : SUITE 190
City : DES MOINES
State : IA
Zip : 50314-2527
Country : US
Telephone Number : 515-244-9136
Fax Number :
Provider Business Practice Location Address
First Line : 1111 9TH ST
Second Line : SUITE 190
City : DES MOINES
State : IA
Zip : 50314-2527
Country : US
Telephone Number : 515-244-9136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2013
Last Update Date : 11/06/2014

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Directions to “ DR. PETER MICHAEL BLOUGH DDS” Practice Location

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