Provider Demographics
NPI:1235268756
Name:PECK, WILLIAM T (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:PECK
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 1:1507 N VETERANS PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-0904
Mailing Address - Country:US
Mailing Address - Phone:309-664-5033
Mailing Address - Fax:309-663-0967
Practice Address - Street 1:1507 N VETERANS PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-0904
Practice Address - Country:US
Practice Address - Phone:309-664-5033
Practice Address - Fax:309-663-0967
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist