Provider Demographics
NPI:1336166792
Name:MARAGOS, PETER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:MARAGOS
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 1:206 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1118
Mailing Address - Country:US
Mailing Address - Phone:330-273-4867
Mailing Address - Fax:330-273-4868
Practice Address - Street 1:206 PEARL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1118
Practice Address - Country:US
Practice Address - Phone:330-273-4867
Practice Address - Fax:330-273-4868
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH205791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20579OtherLICENSE NUMBER
OH30-0051464OtherTIN
OH34-1039197OtherTIN