MEDICARE: DR. DANIEL A PEGUERO 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	1223G0001X	General Practice Dentistry	DN14643	FL
2	1223P0300X	Periodontics	DN12894	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203538298	OTHER	FL	FEDERAL TAX ID

General Provider Information

NPI Number	:	1952442097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL A PEGUERO D.D.S.

Provider Business Mailing Address
First Line	:	3401 S CONGRESS AVE STE 109
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3065
Country	:	US
Telephone Number	:	561-357-4756
Fax Number	:	561-357-4979

Provider Business Practice Location Address
First Line	:	3401 S CONGRESS AVE STE 109
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3065
Country	:	US
Telephone Number	:	561-357-4756
Fax Number	:	561-357-4979

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

Provider Enumeration Date	:	02/10/2007
Last Update Date	:	04/02/2014

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