Provider Demographics
NPI:1952520140
Name:PEURACH, JAMES CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CARL
Last Name:PEURACH
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 1:1510 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1007
Mailing Address - Country:US
Mailing Address - Phone:269-945-3358
Mailing Address - Fax:269-945-3424
Practice Address - Street 1:1510 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1007
Practice Address - Country:US
Practice Address - Phone:269-945-3358
Practice Address - Fax:269-945-3424
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0141251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice