Provider Demographics
NPI:1659331452
Name:GARCHOW, PETER ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ALAN
Last Name:GARCHOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 36TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4005
Mailing Address - Country:US
Mailing Address - Phone:616-538-9020
Mailing Address - Fax:616-538-5353
Practice Address - Street 1:630 36TH ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49509-4005
Practice Address - Country:US
Practice Address - Phone:616-538-9020
Practice Address - Fax:616-538-5353
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist