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General NPI Number Information
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NPI Number | 1720800543
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Entity Type | Organization
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Legal Business Name | PEERY FAMILY DENTISTRY
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 30 N 100 E
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City | LOGAN
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State | UT
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Zip | 84321-4649
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Country | US
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Telephone | 435-752-1362
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Fax | 435-752-2669
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Provider Business Mailing Address
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Address Line | 30 N 100 E
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City | LOGAN
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State | UT
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Zip | 84321-4649
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Country | US
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Telephone | 435-752-1362
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Fax | 435-752-2669
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Authorized Official
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Title or Position | DENTIST
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Name | SAMUEL L PEERY
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Credential | DMD
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Telephone | 435-752-1362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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