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NPI Code Detail

MEDICARE: JOSEPH W PECK DMD

MEDICARE: JOSEPH W PECK DMD
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
1122300000XDentistDN 19856FL
2122300000XDentist8490181-9921UT

General Provider Information

NPI Number : 1609131556
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH W PECK DMD
Provider Business Mailing Address
First Line : 6 LEGEND LN
Second Line :
City : SANDY
State : UT
Zip : 84092-4801
Country : US
Telephone Number : 412-401-8712
Fax Number :
Provider Business Practice Location Address
First Line : 1844 E 9400 S
Second Line :
City : SANDY
State : UT
Zip : 84093-3000
Country : US
Telephone Number : 801-816-9366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2012
Last Update Date : 01/02/2013

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Directions to “ JOSEPH W PECK DMD” Practice Location

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