Provider Demographics
NPI:1821150160
Name:KARL D PEACH DDS MS
Entity Type:Organization
Organization Name:KARL D PEACH DDS MS
Other - Org Name:PEACH ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:PEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:208-777-1010
Mailing Address - Street 1:1145 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854
Mailing Address - Country:US
Mailing Address - Phone:208-777-1010
Mailing Address - Fax:208-773-0667
Practice Address - Street 1:1145 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-777-1010
Practice Address - Fax:208-773-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN053061223X0400X
WADE000072911223X0400X
CA372731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty