Provider Demographics
NPI:1245395078
Name:BURNS, PEGGY (DDS)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 ALDINE MAIL RTE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-5530
Mailing Address - Country:US
Mailing Address - Phone:281-573-5156
Mailing Address - Fax:832-243-6531
Practice Address - Street 1:2421 ALDINE MAIL RTE
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-5530
Practice Address - Country:US
Practice Address - Phone:281-573-5156
Practice Address - Fax:832-243-6531
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH184731223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076119200Medicaid