Provider Demographics
NPI:1821781667
Name:PELOQUIN, ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:PELOQUIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 W HILLSBORO BLVD # 201
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11800 S MILITARY TRL STE 102
Practice Address - Street 2:
Practice Address - City:GOLF
Practice Address - State:FL
Practice Address - Zip Code:33436-5501
Practice Address - Country:US
Practice Address - Phone:401-241-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN279221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice