Provider Demographics
NPI:1770835787
Name:DENTON, PEGGY (IBCLC)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:DENTON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3700
Mailing Address - Country:US
Mailing Address - Phone:928-771-3121
Mailing Address - Fax:928-771-3369
Practice Address - Street 1:10 S 6TH ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4236
Practice Address - Country:US
Practice Address - Phone:928-634-6820
Practice Address - Fax:928-634-6862
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11076311174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11076311OtherIBCLC