Provider Demographics
NPI:1013109727
Name:CARL PEISER, D.D.S.
Entity Type:Organization
Organization Name:CARL PEISER, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEISER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-367-1682
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-0312
Mailing Address - Country:US
Mailing Address - Phone:928-367-1682
Mailing Address - Fax:928-367-2702
Practice Address - Street 1:1525 SOUTH CREEL AVE
Practice Address - Street 2:
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935
Practice Address - Country:US
Practice Address - Phone:928-367-1682
Practice Address - Fax:928-367-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty