MEDICARE: DR. APARECIO DONNELL PEGGINS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	13487	NC

General Provider Information

NPI Number	:	1427836584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. APARECIO DONNELL PEGGINS DDS

Provider Business Mailing Address
First Line	:	SMOKE BOMB HILL DENTAL CLINIC 3718 GRUBER RD RM 156A
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	901-461-0867
Fax Number	:

Provider Business Practice Location Address
First Line	:	SMOKE BOMB HILL DENTAL CLINIC 3718 GRUBER RD RM 156A
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	901-461-0867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	03/03/2026

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