Provider Demographics
NPI:1669821211
Name:PEYSER, JOSHUA (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:PEYSER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:PEYSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1600 MARINA RD
Mailing Address - Street 2:312A
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8445
Mailing Address - Country:US
Mailing Address - Phone:843-513-4951
Mailing Address - Fax:
Practice Address - Street 1:203 N LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2833
Practice Address - Country:US
Practice Address - Phone:803-619-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry