Provider Demographics
NPI:1114282837
Name:PRANCKUN, PETER J (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:PRANCKUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9698
Mailing Address - Country:US
Mailing Address - Phone:717-823-6324
Mailing Address - Fax:
Practice Address - Street 1:601 N 6TH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-1313
Practice Address - Country:US
Practice Address - Phone:717-336-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice