Provider Demographics
NPI:1063895258
Name:PEAVEY, JAVOUS (DMD)
Entity type:Individual
Prefix:DR
First Name:JAVOUS
Middle Name:
Last Name:PEAVEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-5777
Mailing Address - Country:US
Mailing Address - Phone:662-205-5070
Mailing Address - Fax:
Practice Address - Street 1:1168 CROSS CREEK DR
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-5777
Practice Address - Country:US
Practice Address - Phone:662-205-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3905-161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice