Provider Demographics
NPI:1720723596
Name:POPEK, PETER TOM (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:TOM
Last Name:POPEK
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 1:2045 WESTLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2605
Mailing Address - Country:US
Mailing Address - Phone:206-207-0200
Mailing Address - Fax:
Practice Address - Street 1:2045 WESTLAKE AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2605
Practice Address - Country:US
Practice Address - Phone:206-207-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61433011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist