Provider Demographics
NPI:1083829725
Name:PEURA, RICHARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:PEURA
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 1:708 CHIPPEWA SQ
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4814
Mailing Address - Country:US
Mailing Address - Phone:906-228-9594
Mailing Address - Fax:
Practice Address - Street 1:708 CHIPPEWA SQ
Practice Address - Street 2:SUITE 1
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4814
Practice Address - Country:US
Practice Address - Phone:906-228-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP0100171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice