Provider Demographics
NPI:1285650531
Name:SMRECEK, PETER THOMAS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:THOMAS
Last Name:SMRECEK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 806
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-759-8606
Mailing Address - Fax:949-759-8609
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 806
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-759-8606
Practice Address - Fax:949-759-8609
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA288171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice