Provider Demographics
NPI:1083083737
Name:PETER W. PICHE, D.D.S., P.C.
Entity Type:Organization
Organization Name:PETER W. PICHE, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PICHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-947-2716
Mailing Address - Street 1:335 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2516
Mailing Address - Country:US
Mailing Address - Phone:231-947-2716
Mailing Address - Fax:231-947-2352
Practice Address - Street 1:335 E STATE ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2516
Practice Address - Country:US
Practice Address - Phone:231-947-2716
Practice Address - Fax:231-947-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty