Provider Demographics
NPI:1093813792
Name:PEGEL, TERENCE B (TERENCE PEGEL DDS)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:B
Last Name:PEGEL
Suffix:
Gender:M
Credentials:TERENCE PEGEL DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6285 LUSK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2731
Mailing Address - Country:US
Mailing Address - Phone:858-755-3515
Mailing Address - Fax:
Practice Address - Street 1:6285 LUSK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2731
Practice Address - Country:US
Practice Address - Phone:858-755-3515
Practice Address - Fax:858-755-1406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice