Provider Demographics
NPI:1285821439
Name:PEGGY D. PRESTON, DDS, LTD.
Entity Type:Organization
Organization Name:PEGGY D. PRESTON, DDS, LTD.
Other - Org Name:MOANA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-827-8808
Mailing Address - Street 1:3502 S VIRGINIA ST
Mailing Address - Street 2:SUITE A4
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6038
Mailing Address - Country:US
Mailing Address - Phone:775-827-8808
Mailing Address - Fax:775-827-9297
Practice Address - Street 1:3502 S VIRGINIA ST
Practice Address - Street 2:SUITE A4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6038
Practice Address - Country:US
Practice Address - Phone:775-827-8808
Practice Address - Fax:775-827-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty