Provider Demographics
NPI:1770686677
Name:SHEK, PETER K (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
Last Name:SHEK
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 1:1401 S ANAHEIM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6214
Mailing Address - Country:US
Mailing Address - Phone:714-772-9800
Mailing Address - Fax:714-772-6800
Practice Address - Street 1:1401 S ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6214
Practice Address - Country:US
Practice Address - Phone:714-772-9800
Practice Address - Fax:714-772-6800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice