Provider Demographics
NPI:1427325117
Name:RAMON D. PELEAUX, DDS, MD. P.A.
Entity type:Organization
Organization Name:RAMON D. PELEAUX, DDS, MD. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:PELEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:980-224-7737
Mailing Address - Street 1:3541 RANDOLPH RD
Mailing Address - Street 2:302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1082
Mailing Address - Country:US
Mailing Address - Phone:980-224-7737
Mailing Address - Fax:980-224-7769
Practice Address - Street 1:3541 RANDOLPH RD
Practice Address - Street 2:302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1082
Practice Address - Country:US
Practice Address - Phone:980-224-7737
Practice Address - Fax:980-224-7769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8966771Medicaid
NCF80668Medicare UPIN
NC8966771Medicaid