Provider Demographics
NPI:1225437619
Name:PETER D. GAUGER DDS PLLC
Entity Type:Organization
Organization Name:PETER D. GAUGER DDS PLLC
Other - Org Name:TACOMA ORAL SURGERY & IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GAUGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-572-4601
Mailing Address - Street 1:1550 S UNION AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1946
Mailing Address - Country:US
Mailing Address - Phone:253-572-4601
Mailing Address - Fax:
Practice Address - Street 1:1550 S UNION AVE STE 250
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1946
Practice Address - Country:US
Practice Address - Phone:253-572-4601
Practice Address - Fax:253-572-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 602163111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty