Provider Demographics
NPI:1073526679
Name:PEELE, MICHAEL ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:PEELE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-0582
Mailing Address - Country:US
Mailing Address - Phone:919-542-4911
Mailing Address - Fax:919-542-5714
Practice Address - Street 1:587 OLD GRAHAM RD.
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312
Practice Address - Country:US
Practice Address - Phone:919-542-4911
Practice Address - Fax:919-542-5714
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC96773OtherBLUE CROSS BLUE SHIELD
NC668537OtherUNITED CONCORDIA
NC8996773Medicaid