Provider Demographics
NPI:1417089608
Name:PEAY, ERIC M (DDS DOCTOR OF DENTAL)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:PEAY
Suffix:
Gender:M
Credentials:DDS DOCTOR OF DENTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 NORTH 40TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3603
Mailing Address - Country:US
Mailing Address - Phone:602-955-4890
Mailing Address - Fax:602-955-0401
Practice Address - Street 1:4519 NORTH 40TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3603
Practice Address - Country:US
Practice Address - Phone:602-955-4890
Practice Address - Fax:602-955-0401
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice