Provider Demographics
NPI:1346379948
Name:CIAMPA, PETER R (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:CIAMPA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7911
Mailing Address - Country:US
Mailing Address - Phone:270-442-4374
Mailing Address - Fax:270-442-1878
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7911
Practice Address - Country:US
Practice Address - Phone:270-442-4374
Practice Address - Fax:270-442-1878
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55521223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64055528Medicaid
KY5425050OtherUNITED CONCORDIA
KY60055522Medicaid
KY5425050OtherUNITED CONCORDIA
KY64055528Medicaid