Provider Demographics
NPI:1326107830
Name:PEET, EUGENE ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ARTHUR
Last Name:PEET
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 1:14727 60TH ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6323
Mailing Address - Country:US
Mailing Address - Phone:651-439-9060
Mailing Address - Fax:
Practice Address - Street 1:14727 60TH ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6323
Practice Address - Country:US
Practice Address - Phone:651-439-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN685522900Medicaid