Provider Demographics
NPI:1386647139
Name:TRAGER, PETER S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:TRAGER
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 1:2480 WINDY HILL RD SE
Mailing Address - Street 2:STE 405
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8658
Mailing Address - Country:US
Mailing Address - Phone:770-952-0136
Mailing Address - Fax:770-952-0137
Practice Address - Street 1:2480 WINDY HILL RD SE
Practice Address - Street 2:STE 405
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8658
Practice Address - Country:US
Practice Address - Phone:770-952-0136
Practice Address - Fax:770-952-0137
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00051785BMedicaid