Provider Demographics
NPI:1770637027
Name:CHAPPELL, PEGGY M (DMD)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:M
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NC
Mailing Address - Zip Code:27919-9714
Mailing Address - Country:US
Mailing Address - Phone:252-297-9788
Mailing Address - Fax:
Practice Address - Street 1:2303 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4330
Practice Address - Country:US
Practice Address - Phone:757-539-9481
Practice Address - Fax:757-539-2338
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA57281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006606OtherBLUE CROSS
VA840832OtherUNITED CONCORDIA