Provider Demographics
NPI:1881865186
Name:DR. MICHAEL A. PEELE
Entity Type:Organization
Organization Name:DR. MICHAEL A. PEELE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-542-4911
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-0582
Mailing Address - Country:US
Mailing Address - Phone:919-542-4911
Mailing Address - Fax:919-542-5714
Practice Address - Street 1:587 OLD GRAHAM RD
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312
Practice Address - Country:US
Practice Address - Phone:919-542-4911
Practice Address - Fax:919-542-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC668537OtherUNITED CONCORDIA
NC8996773Medicaid
NC96773OtherBLUE CROSS BLUE SHIELD