Provider Demographics
NPI:1104874924
Name:PESKIN, HOWARD (DDS, MSCD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:PESKIN
Suffix:
Gender:M
Credentials:DDS, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7275
Mailing Address - Country:US
Mailing Address - Phone:843-571-7700
Mailing Address - Fax:843-571-0684
Practice Address - Street 1:494 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7275
Practice Address - Country:US
Practice Address - Phone:843-571-7700
Practice Address - Fax:843-571-0684
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19971223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC794763OtherUNITED CONCORDIA
SCZ19971Medicaid