Provider Demographics
NPI:1346259744
Name:PECKOSH, VALERIE BUDAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:BUDAR
Last Name:PECKOSH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:WALLACE
Other - Last Name:BUDAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3455 STONEMAN RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-5269
Mailing Address - Country:US
Mailing Address - Phone:563-582-1478
Mailing Address - Fax:563-582-1479
Practice Address - Street 1:3455 STONEMAN RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5269
Practice Address - Country:US
Practice Address - Phone:563-582-1478
Practice Address - Fax:563-582-1479
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0186940Medicaid
IAI10250Medicare ID - Type Unspecified
IA0186940Medicaid