Provider Demographics
NPI:1982664439
Name:CHASE, PETER F (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:F
Last Name:CHASE
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:PO BOX 1543
Mailing Address - Street 2:
Mailing Address - City:ROSS
Mailing Address - State:CA
Mailing Address - Zip Code:94957-1543
Mailing Address - Country:US
Mailing Address - Phone:415-785-3210
Mailing Address - Fax:415-785-3746
Practice Address - Street 1:130 LA CASA VIA
Practice Address - Street 2:BUILDING #2, SUITE 104
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3045
Practice Address - Country:US
Practice Address - Phone:925-935-2918
Practice Address - Fax:925-935-1532
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6199260001Medicare NSC
CAT08361Medicare UPIN