Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D7321 | OR |
NPI | 1003982950 |
---|---|
Provider Name | Mr. Steven Michael Peck |
First Address | Salem, OR 97301 |
Second Address | Salem, OR 97301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 08/07/2007 |