Provider Demographics
NPI:1609131556
Name:PECK, JOSEPH W (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:PECK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LEGEND LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4801
Mailing Address - Country:US
Mailing Address - Phone:412-401-8712
Mailing Address - Fax:
Practice Address - Street 1:1844 E 9400 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-3000
Practice Address - Country:US
Practice Address - Phone:801-816-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19856122300000X
UT8490181-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist