Provider Demographics
NPI:1003838269
Name:PEGG, DUANE W (DMD)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:W
Last Name:PEGG
Suffix:
Gender:M
Credentials:DMD
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 2672
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98595-2672
Mailing Address - Country:US
Mailing Address - Phone:360-268-6225
Mailing Address - Fax:360-268-6095
Practice Address - Street 1:509 SO. MONTESANO STREET
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:WA
Practice Address - Zip Code:98595-2672
Practice Address - Country:US
Practice Address - Phone:360-268-6225
Practice Address - Fax:360-268-6095
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000083501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5047329Medicaid
WA145903OtherDEPT. OF L & I