Provider Demographics
NPI:1659578169
Name:ERIC M. PEAY, DDS, PC
Entity Type:Organization
Organization Name:ERIC M. PEAY, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MERLIN
Authorized Official - Last Name:PEAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-955-4890
Mailing Address - Street 1:4519 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3603
Mailing Address - Country:US
Mailing Address - Phone:602-955-4890
Mailing Address - Fax:
Practice Address - Street 1:4519 N 40TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3603
Practice Address - Country:US
Practice Address - Phone:602-955-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD38961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty