Provider Demographics
NPI:1235271883
Name:TIM G PEFFLY DDS INC
Entity Type:Organization
Organization Name:TIM G PEFFLY DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:G
Authorized Official - Last Name:PEFFLY
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST DDS
Authorized Official - Phone:559-673-8044
Mailing Address - Street 1:615 NORTH I STREET
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637
Mailing Address - Country:US
Mailing Address - Phone:559-673-8044
Mailing Address - Fax:559-673-5447
Practice Address - Street 1:615 NORTH I STREET
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637
Practice Address - Country:US
Practice Address - Phone:559-673-8044
Practice Address - Fax:559-673-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2837301OtherDENTICAL