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NPI Code Detail

MEDICARE: DR. SCOTT RICHARD PECK D.D.S.

MEDICARE: DR. SCOTT RICHARD 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
1122300000XDentistDE60263888WA

General Provider Information

NPI Number : 1720058720
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT RICHARD PECK D.D.S.
Provider Business Mailing Address
First Line : 1144 HIGH SCHOOL RD NE
Second Line :
City : BAINBRIDGE ISLAND
State : WA
Zip : 98110-3908
Country : US
Telephone Number : 206-855-8108
Fax Number :
Provider Business Practice Location Address
First Line : 9709 3RD AVE NE
Second Line : SUITE 400
City : SEATTLE
State : WA
Zip : 98115-2062
Country : US
Telephone Number : 206-322-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2006
Last Update Date : 06/24/2013

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