Healthcare Provider Details

I. General information

NPI: 1619196235
Provider Name (Legal Business Name): GEORGE A. PEEPLES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 SANTA ANITA AVE
EL MONTE CA
91780
US

IV. Provider business mailing address

1032 LOMA LISA LN
ARCADIA CA
91006-2218
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-2605
  • Fax:
Mailing address:
  • Phone: 626-824-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number027913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: