Provider Demographics
NPI:1740549534
Name:WURM, PEGGY (DDS)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:WURM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 33RD ST
Mailing Address - Street 2:SUITE 28J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4874
Mailing Address - Country:US
Mailing Address - Phone:646-522-4347
Mailing Address - Fax:212-679-3039
Practice Address - Street 1:200 E 33RD ST
Practice Address - Street 2:SUITE 28J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4874
Practice Address - Country:US
Practice Address - Phone:646-522-4347
Practice Address - Fax:212-679-3039
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0340331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice