Provider Demographics
NPI:1285051656
Name:DANIEL PECK DDS INC PS
Entity type:Organization
Organization Name:DANIEL PECK DDS INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-779-5546
Mailing Address - Street 1:20855 BOND RD NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9014
Mailing Address - Country:US
Mailing Address - Phone:360-779-5546
Mailing Address - Fax:360-697-4951
Practice Address - Street 1:20855 BOND RD NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9014
Practice Address - Country:US
Practice Address - Phone:360-779-5546
Practice Address - Fax:360-697-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA109411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty