Provider Demographics
NPI:1427111558
Name:PECK, SHELDON L (DDS MS PC)
Entity type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:L
Last Name:PECK
Suffix:
Gender:M
Credentials:DDS MS PC
Other - Prefix:
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Mailing Address - Street 1:1747 S HERITAGE LANE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075
Mailing Address - Country:US
Mailing Address - Phone:801-525-1333
Mailing Address - Fax:801-525-1448
Practice Address - Street 1:1747 S HERITAGE LANE
Practice Address - Street 2:SUITE A3
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075
Practice Address - Country:US
Practice Address - Phone:801-525-1333
Practice Address - Fax:801-525-1448
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT28282499211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics