Provider Demographics
NPI:1215096607
Name:PEFFLEY, GEORGE EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:PEFFLEY
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 1:422 E KIRKWOOD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-4016
Mailing Address - Country:US
Mailing Address - Phone:812-332-0453
Mailing Address - Fax:
Practice Address - Street 1:422 E KIRKWOOD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-4016
Practice Address - Country:US
Practice Address - Phone:812-332-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12005503A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist