Provider Demographics
NPI:1659462620
Name:DEMLEIN, PETER J (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:DEMLEIN
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 1:308 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1707
Mailing Address - Country:US
Mailing Address - Phone:315-687-7831
Mailing Address - Fax:315-687-7831
Practice Address - Street 1:308 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1707
Practice Address - Country:US
Practice Address - Phone:315-687-7831
Practice Address - Fax:315-687-7831
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0374331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00796401Medicaid