Provider Demographics
NPI:1750374740
Name:PEEPLES, EUGENE H (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:H
Last Name:PEEPLES
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 1:1000 UNION AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1589
Mailing Address - Country:US
Mailing Address - Phone:360-357-5290
Mailing Address - Fax:360-357-3260
Practice Address - Street 1:1000 UNION AVE SE
Practice Address - Street 2:#101
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1589
Practice Address - Country:US
Practice Address - Phone:360-357-5290
Practice Address - Fax:360-357-3260
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000053081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA05731OtherWASHINGTON DENTAL SERVICE
WA0093410OtherLABOR & INDUSTRIES
WA5011606Medicaid