Provider Demographics
NPI:1972594372
Name:PECK, WILLIAM MAURICE (DDS,MPH)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MAURICE
Last Name:PECK
Suffix:
Gender:M
Credentials:DDS,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MCCALLIE AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2089
Mailing Address - Country:US
Mailing Address - Phone:426-634-5889
Mailing Address - Fax:423-634-3139
Practice Address - Street 1:540 MCCALLIE AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2089
Practice Address - Country:US
Practice Address - Phone:426-634-5889
Practice Address - Fax:423-634-3139
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 27391223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1854131Medicaid