=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629021423
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMON DENNIS PELEAUX DDS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 05/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3541 RANDOLPH RD 302
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28211-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-224-7737
-----------------------------------------------------
Fax | 980-224-7769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3541 RANDOLPH RD 302
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28211-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-224-7737
-----------------------------------------------------
Fax | 980-224-7769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 9300560
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 6073
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------