Provider Demographics
NPI:1457446478
Name:PETER M SINCLAIR DDS PC
Entity Type:Organization
Organization Name:PETER M SINCLAIR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:310-375-0001
Mailing Address - Street 1:23451 MADISON ST
Mailing Address - Street 2:130
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4736
Mailing Address - Country:US
Mailing Address - Phone:310-375-0001
Mailing Address - Fax:310-373-8405
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:130
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4736
Practice Address - Country:US
Practice Address - Phone:310-375-0001
Practice Address - Fax:310-373-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty