Provider Demographics
NPI:1952442097
Name:PEGUERO, DANIEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:PEGUERO
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 1:3401 S CONGRESS AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3065
Mailing Address - Country:US
Mailing Address - Phone:561-357-4756
Mailing Address - Fax:561-357-4979
Practice Address - Street 1:3401 S CONGRESS AVE STE 109
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3065
Practice Address - Country:US
Practice Address - Phone:561-357-4756
Practice Address - Fax:561-357-4979
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146431223G0001X
FLDN128941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203538298OtherFEDERAL TAX ID