Provider Demographics
NPI:1205905692
Name:ELLOWAY, PETER K (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
Last Name:ELLOWAY
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 1:26357 MCBEAN PKWY
Mailing Address - Street 2:SUITE #240
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4488
Mailing Address - Country:US
Mailing Address - Phone:661-259-8755
Mailing Address - Fax:661-259-8758
Practice Address - Street 1:26357 MCBEAN PKWY
Practice Address - Street 2:SUITE #240
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4488
Practice Address - Country:US
Practice Address - Phone:661-259-8755
Practice Address - Fax:661-259-8758
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA222301OtherDENTI-CAL