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General NPI Number Information
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NPI Number | 1548339997
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Entity Type | Individual
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Provider Name | WADE A PEERS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 2750 RASMUSSEN RD STE 106
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City | PARK CITY
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State | UT
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Zip | 84098-5401
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Country | US
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Telephone | 435-615-9840
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Fax | 435-615-9842
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Provider Business Mailing Address
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Address Line | 2750 RASMUSSEN RD STE 106
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City | PARK CITY
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State | UT
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Zip | 84098-5401
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Country | US
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Telephone | 435-615-9840
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Fax | 435-615-9842
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 98362987
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License Number State | UT
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