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NPI Code Detail

MEDICARE: DR. RUSSELL C PECK D.D.S.

MEDICARE: DR. RUSSELL C PECK D.D.S.
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
11223S0112XOral and Maxillofacial Surgery (Dentist)DS4250TN

General Provider Information

NPI Number : 1649249533
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSELL C PECK D.D.S.
Provider Business Mailing Address
First Line : 5346 WILDBROOK CV
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-2759
Country : US
Telephone Number : 901-734-0919
Fax Number :
Provider Business Practice Location Address
First Line : 116 N PAULINE ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-1005
Country : US
Telephone Number : 901-523-8990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 02/04/2026

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