Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 16270 | MD |
NPI | 1144510827 |
---|---|
Provider Name | Dr. David Peto |
First Address | Owings Mills, MD 21117-4593 |
Second Address | Owings Mills, MD 21117-4593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 16/07/2018 |