MEDICARE: DR. EUGENE H 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	1223G0001X	General Practice Dentistry	DE00005308	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05731	OTHER	WA	WASHINGTON DENTAL SERVICE
2	0093410	OTHER	WA	LABOR & INDUSTRIES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750374740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE H PEEPLES DDS

Provider Business Mailing Address
First Line	:	1000 UNION AVE SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-1589
Country	:	US
Telephone Number	:	360-357-5290
Fax Number	:	360-357-3260

Provider Business Practice Location Address
First Line	:	1000 UNION AVE SE
Second Line	:	#101
City	:	OLYMPIA
State	:	WA
Zip	:	98501-1589
Country	:	US
Telephone Number	:	360-357-5290
Fax Number	:	360-357-3260

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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