Provider Demographics
NPI:1386084184
Name:PEEK, KALEY ELLYN (DMD)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:ELLYN
Last Name:PEEK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-2117
Mailing Address - Country:US
Mailing Address - Phone:864-476-3212
Mailing Address - Fax:864-602-2162
Practice Address - Street 1:420 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-2117
Practice Address - Country:US
Practice Address - Phone:864-476-3212
Practice Address - Fax:864-602-2162
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice