Healthcare Provider Details

I. General information

NPI: 1295703387
Provider Name (Legal Business Name): MANUEL NMN PELAEZ DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/14/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA DENTAC FT STEWART 351 W. 6TH STREET
FORT STEWART GA
31314
US

IV. Provider business mailing address

USA DENTAC FT STEWART 351 W. 6TH STREET, SUITE 100
FORT STEWART GA
31314
US

V. Phone/Fax

Practice location:
  • Phone: 912-767-8305
  • Fax:
Mailing address:
  • Phone: 912-767-8305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS035547
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS035547
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: