Provider Demographics
NPI:1285674416
Name:PEER, MICHAEL CONRAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CONRAD
Last Name:PEER
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 1:1997 HAMILTON BLVD.
Mailing Address - Street 2:P.O. BOX 752
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592
Mailing Address - Country:US
Mailing Address - Phone:434-575-5677
Mailing Address - Fax:434-572-8313
Practice Address - Street 1:1997 HAMILTON BLVD.
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592
Practice Address - Country:US
Practice Address - Phone:434-575-5677
Practice Address - Fax:434-572-8313
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist