Provider Demographics
NPI:1568042604
Name:WALTER N. PEAVLER, DMD, PLLC
Entity Type:Organization
Organization Name:WALTER N. PEAVLER, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAVLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-682-4807
Mailing Address - Street 1:198 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1674
Mailing Address - Country:US
Mailing Address - Phone:859-744-0320
Mailing Address - Fax:
Practice Address - Street 1:198 REDWING DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1674
Practice Address - Country:US
Practice Address - Phone:859-744-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty