Provider Demographics
NPI:1912072166
Name:BUDHU, PEGGY LAURA NEROOPAH (DDS)
Entity type:Individual
Prefix:DR
First Name:PEGGY LAURA
Middle Name:NEROOPAH
Last Name:BUDHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 CHURCH AVE
Mailing Address - Street 2:DENTAL DEPT.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2714
Mailing Address - Country:US
Mailing Address - Phone:718-630-2188
Mailing Address - Fax:718-630-2182
Practice Address - Street 1:3414 CHURCH AVE
Practice Address - Street 2:DENTAL DEPT.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2714
Practice Address - Country:US
Practice Address - Phone:718-630-2188
Practice Address - Fax:718-630-2182
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0458781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice