Provider Demographics
NPI:1518968130
Name:PECK, MEGAN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:E
Last Name:PECK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5830 SHOREVIEW LN. N.
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303
Mailing Address - Country:US
Mailing Address - Phone:503-390-4117
Mailing Address - Fax:503-390-8342
Practice Address - Street 1:5830 SHOREVIEW LN. N.
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:503-390-4117
Practice Address - Fax:503-390-8342
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice