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General NPI Number Information
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NPI Number | 1558511717
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Entity Type | Individual
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Provider Name | PETER M ELTON D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | LANDSTUHL DENTAL ACTIVITY, CREDENTIALS OFFICE CMR 402
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City | APO
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State | AE
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Zip | 09180
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Country | US
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Telephone | 496371929130
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Fax | 496371929191
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Provider Business Mailing Address
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Address Line | LANDSTUHL DENTAL ACTIVITY, CREDENTIALS OFFICE CMR 402
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City | APO
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State | AE
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Zip | 09180
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Country | US
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Telephone | 496371929130
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Fax | 496371929191
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE60026108
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License Number State | WA
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