MEDICARE: DR. CHRISTIAN A PEABODY 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	2901011507	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	115070	OTHER	MI	DENTAL PROVIDER BCBS
3	443416	OTHER	MI	DENTAL PRVDR.# FOR UCCI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	913785	OTHER	MI	DENTAL PRVDR.# FOR UCCI

General Provider Information

NPI Number	:	1932106564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN A PEABODY DDS

Provider Business Mailing Address
First Line	:	2201 S. GETTY STREET
Second Line	:
City	:	MUSKEGON HEIGHTS
State	:	MI
Zip	:	49444-1207
Country	:	US
Telephone Number	:	231-767-9830
Fax Number	:	231-773-2454

Provider Business Practice Location Address
First Line	:	2201 S. GETTY STREET
Second Line	:
City	:	MUSKEGON HTS.
State	:	MI
Zip	:	49444-1207
Country	:	US
Telephone Number	:	231-767-9830
Fax Number	:	231-773-2454

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	10/27/2015

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