Provider Demographics
NPI:1225229339
Name:MAYER, PETER GARVEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GARVEY
Last Name:MAYER
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 1:2655 CAMINO DEL RIO N STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1603
Mailing Address - Country:US
Mailing Address - Phone:619-282-7088
Mailing Address - Fax:619-297-0504
Practice Address - Street 1:2655 CAMINO DEL RIO N STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1603
Practice Address - Country:US
Practice Address - Phone:619-282-7088
Practice Address - Fax:619-297-0504
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics