MEDICARE: DR. GEORGE A. PEEPLES 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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	027913	CA

General Provider Information

NPI Number	:	1619196235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE A. PEEPLES DDS

Provider Business Mailing Address
First Line	:	1032 LOMA LISA LN
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-2218
Country	:	US
Telephone Number	:	626-824-0073
Fax Number	:

Provider Business Practice Location Address
First Line	:	3113 SANTA ANITA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91780
Country	:	US
Telephone Number	:	626-444-2605
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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