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General NPI Number Information
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NPI Number | 1821150160
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Entity Type | Organization
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Legal Business Name | KARL D PEACH DDS MS
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1145 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854
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Country | US
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Telephone | 208-777-1010
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Fax | 208-773-0667
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Provider Business Mailing Address
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Address Line | 1145 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854
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Country | US
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Telephone | 208-777-1010
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Fax | 208-773-0667
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Authorized Official
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Title or Position | ORTHODONTIST PRESIDENT
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Name | DR. KARL DOUGLAS PEACH
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Credential | DDS MS
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Telephone | 208-777-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE00007291
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 37273
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | N05306
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License Number State | ID
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