Healthcare Provider Details

I. General information

NPI: 1629021423
Provider Name (Legal Business Name): RAMON DENNIS PELEAUX DDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3541 RANDOLPH RD 302
CHARLOTTE NC
28211-1082
US

IV. Provider business mailing address

3541 RANDOLPH RD 302
CHARLOTTE NC
28211-1082
US

V. Phone/Fax

Practice location:
  • Phone: 980-224-7737
  • Fax: 980-224-7769
Mailing address:
  • Phone: 980-224-7737
  • Fax: 980-224-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9300560
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6073
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: