Provider Demographics
NPI:1164720520
Name:JAMES PECK DDS PLLC
Entity Type:Organization
Organization Name:JAMES PECK DDS PLLC
Other - Org Name:REDBUD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:PECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-562-9550
Mailing Address - Street 1:18001 N WESTERN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012
Mailing Address - Country:US
Mailing Address - Phone:405-562-9550
Mailing Address - Fax:
Practice Address - Street 1:18001 N WESTERN AVE STE 106
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012
Practice Address - Country:US
Practice Address - Phone:405-562-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty