Provider Demographics
NPI:1942395918
Name:PESHOFF, CARL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:M
Last Name:PESHOFF
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 1:2223 FULTON RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3554
Mailing Address - Country:US
Mailing Address - Phone:330-454-3000
Mailing Address - Fax:330-454-3205
Practice Address - Street 1:2223 FULTON RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3554
Practice Address - Country:US
Practice Address - Phone:330-454-3000
Practice Address - Fax:330-454-3205
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics