Provider Demographics
NPI:1114937083
Name:PELTZ, RICHARD EARL (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EARL
Last Name:PELTZ
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 1:1211 CORTINA DR.
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963
Mailing Address - Country:US
Mailing Address - Phone:530-965-5544
Mailing Address - Fax:530-865-9209
Practice Address - Street 1:1211 CORTINA DR.
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963
Practice Address - Country:US
Practice Address - Phone:530-965-5544
Practice Address - Fax:530-865-9209
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist