Provider Demographics
NPI:1598149841
Name:PECK, CAMILLE ALORA (DDS)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ALORA
Last Name:PECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:ALORA
Other - Last Name:DARYAPAYMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3018 SEA CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-1663
Mailing Address - Country:US
Mailing Address - Phone:214-326-5241
Mailing Address - Fax:
Practice Address - Street 1:8202 FM 3180 RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523
Practice Address - Country:US
Practice Address - Phone:281-231-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist