Healthcare Provider Details

I. General information

NPI: 1114012440
Provider Name (Legal Business Name): BARRY DOUGLAS PEYTON D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22221 7TH AVE S SUITE A
DES MOINES WA
98198-6223
US

IV. Provider business mailing address

22221 7TH AVE S SUITE A
DES MOINES WA
98198-6223
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-8288
  • Fax: 206-824-3859
Mailing address:
  • Phone: 206-824-8288
  • Fax: 206-824-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00005751
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: