Provider Demographics
NPI:1215073192
Name:MEDAUGH, PETER CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:CHARLES
Last Name:MEDAUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7768 VANCE DR STE A
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2153
Mailing Address - Country:US
Mailing Address - Phone:303-423-0860
Mailing Address - Fax:303-423-6014
Practice Address - Street 1:7768 VANCE DR STE A
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2153
Practice Address - Country:US
Practice Address - Phone:303-423-0860
Practice Address - Fax:303-423-6014
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice