Provider Demographics
NPI:1629021423
Name:PELEAUX, RAMON DENNIS (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:DENNIS
Last Name:PELEAUX
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 RANDOLPH RD
Mailing Address - Street 2:302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1082
Mailing Address - Country:US
Mailing Address - Phone:980-224-7737
Mailing Address - Fax:980-224-7769
Practice Address - Street 1:3541 RANDOLPH RD
Practice Address - Street 2:302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1082
Practice Address - Country:US
Practice Address - Phone:980-224-7737
Practice Address - Fax:980-224-7769
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93005601223S0112X
NC60731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0607279OtherAETNA
560953592OtherTAX ID
3864523OtherCIGNA
NC8966771Medicaid
01083OtherBCBS
1399117OtherUNITED HEALTHCARE
19578OtherWELLPATH
3864523OtherCIGNA
560953592OtherTAX ID