Provider Demographics
NPI:1588733273
Name:EDDY, PETER S (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:EDDY
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 1:1977 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2493
Mailing Address - Country:US
Mailing Address - Phone:412-664-7312
Mailing Address - Fax:412-664-0402
Practice Address - Street 1:1977 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2493
Practice Address - Country:US
Practice Address - Phone:412-664-7312
Practice Address - Fax:412-664-0402
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO 254420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist