Provider Demographics
NPI:1659065621
Name:PEEGE, KELSEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:PEEGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2125 OAK TREE DR E
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2556
Mailing Address - Country:US
Mailing Address - Phone:502-689-1048
Mailing Address - Fax:
Practice Address - Street 1:5685 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2226
Practice Address - Country:US
Practice Address - Phone:937-256-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0271621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice