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General NPI Number Information
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NPI Number | 1679932107
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Entity Type | Individual
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Provider Name | PETER IVEY DDS
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Gender | Male
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 105 NUCLEUS AVE
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912-4010
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Country | US
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Telephone | 406-892-2104
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Fax |
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Provider Business Mailing Address
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Address Line | 4060 FAIRMOUNT AVE DENTAL
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City | SAN DIEGO
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State | CA
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Zip | 92105-1608
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 23727
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License Number State | MT
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