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General NPI Number Information
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NPI Number | 1952792012
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Entity Type | Organization
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Legal Business Name | WALTON S. PEERY,DDS PA
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 330 BILLINGSLEY RD SUITE 200
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City | CHARLOTTE
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State | NC
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Zip | 28211-5055
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Country | US
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Telephone | 704-365-4142
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Fax | 704-365-4145
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Provider Business Mailing Address
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Address Line | 330 BILLINGSLEY RD SUITE 200
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City | CHARLOTTE
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State | NC
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Zip | 28211-5055
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Country | US
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Telephone | 704-365-4142
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Fax | 704-365-4145
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALTON STEWART PEERY III
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Credential |
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Telephone | 704-365-4142
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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 | NC4523
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License Number State | NC
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