Provider Demographics
NPI:1962541896
Name:PETER SLEPSKY DDS PC
Entity type:Organization
Organization Name:PETER SLEPSKY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEPSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-486-8047
Mailing Address - Street 1:1265 HEBDEN CV
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4607
Mailing Address - Country:US
Mailing Address - Phone:757-486-8047
Mailing Address - Fax:
Practice Address - Street 1:24023 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CAPE CHARLES
Practice Address - State:VA
Practice Address - Zip Code:23310-2153
Practice Address - Country:US
Practice Address - Phone:757-331-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010081911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA15829Medicaid
VA15829Medicaid