Provider Demographics
NPI:1730310426
Name:GAUGER, PETER DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DAVID
Last Name:GAUGER
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 1:3425 ENSIGN RD NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5425
Mailing Address - Country:US
Mailing Address - Phone:360-456-5678
Mailing Address - Fax:360-456-1238
Practice Address - Street 1:3425 ENSIGN RD NE
Practice Address - Street 2:SUITE 310
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5425
Practice Address - Country:US
Practice Address - Phone:360-456-5678
Practice Address - Fax:360-456-1238
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR 600960731223S0112X
WADE 602163111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery