Provider Demographics
NPI:1205022779
Name:PEACOCK, RONALD THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:THOMAS
Last Name:PEACOCK
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 1:3634 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6518
Mailing Address - Country:US
Mailing Address - Phone:706-860-8228
Mailing Address - Fax:706-860-7222
Practice Address - Street 1:3634 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6518
Practice Address - Country:US
Practice Address - Phone:706-860-8228
Practice Address - Fax:706-860-7222
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA0073671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery