MEDICARE: DR. RAMON DENNIS PELEAUX DDS MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9300560	NC
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6073	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0607279	OTHER	AETNA
2	560953592	OTHER	TAX ID
3	3864523	OTHER	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	01083	OTHER	BCBS
6	1399117	OTHER	UNITED HEALTHCARE
7	19578	OTHER	WELLPATH

General Provider Information

NPI Number	:	1629021423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMON DENNIS PELEAUX DDS MD

Provider Business Mailing Address
First Line	:	3541 RANDOLPH RD
Second Line	:	302
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1082
Country	:	US
Telephone Number	:	980-224-7737
Fax Number	:	980-224-7769

Provider Business Practice Location Address
First Line	:	3541 RANDOLPH RD
Second Line	:	302
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1082
Country	:	US
Telephone Number	:	980-224-7737
Fax Number	:	980-224-7769

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/10/2012

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