Provider Demographics
NPI:1003007030
Name:PECK, DANIEL GRANGER
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GRANGER
Last Name:PECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20855 BOND RD NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9014
Mailing Address - Country:US
Mailing Address - Phone:360-779-5546
Mailing Address - Fax:
Practice Address - Street 1:20855 BOND RD NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9014
Practice Address - Country:US
Practice Address - Phone:360-779-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist