Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE00010941 | WA |
NPI | 1003007030 |
---|---|
Provider Name | Dr. Daniel Granger Peck |
First Address | Poulsbo, WA 98370-9014 |
Second Address | Poulsbo, WA 98370-9014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 06/08/2007 |