Provider Demographics
NPI:1891175279
Name:COMETTI, PEYTON D (DDS)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:D
Last Name:COMETTI
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 1:1583 COMMON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3173
Mailing Address - Country:US
Mailing Address - Phone:830-608-1818
Mailing Address - Fax:
Practice Address - Street 1:1583 COMMON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3173
Practice Address - Country:US
Practice Address - Phone:830-608-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30908122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice