Provider Demographics
NPI:1457587065
Name:PEACOCK, ZACHARY SCOTT (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:SCOTT
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT STREET, WARREN 1201
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-2740
Mailing Address - Fax:617-726-6195
Practice Address - Street 1:55 FRUIT STREET, WARREN 1201
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2740
Practice Address - Fax:617-726-6195
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106669204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery