Provider Demographics
NPI:1720472731
Name:PETER, JOSHUA TIMOTHY (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TIMOTHY
Last Name:PETER
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 1:6101 S JERICHO WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1273
Mailing Address - Country:US
Mailing Address - Phone:774-578-6849
Mailing Address - Fax:
Practice Address - Street 1:6101 S JERICHO WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-1273
Practice Address - Country:US
Practice Address - Phone:774-578-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN.00202467OtherDENTAL LICENSE