Provider Demographics
NPI:1730301383
Name:WEST, PETER L (D D S)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:WEST
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PARK GATE DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-3010
Mailing Address - Country:US
Mailing Address - Phone:662-844-7231
Mailing Address - Fax:662-844-0142
Practice Address - Street 1:105 PARK GATE DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3010
Practice Address - Country:US
Practice Address - Phone:662-844-7231
Practice Address - Fax:662-844-0142
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2514-89122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSV07212Medicare UPIN