Provider Demographics
NPI:1497904858
Name:EUGENE H. PEEPLES, DDS
Entity Type:Organization
Organization Name:EUGENE H. PEEPLES, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PEEPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-357-5290
Mailing Address - Street 1:1000 UNION AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1589
Mailing Address - Country:US
Mailing Address - Phone:360-357-5290
Mailing Address - Fax:360-357-3260
Practice Address - Street 1:1000 UNION AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1589
Practice Address - Country:US
Practice Address - Phone:360-357-5290
Practice Address - Fax:360-357-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000053081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0093410OtherLABOR & INDUSTRIES
WA5011606Medicaid