Provider Demographics
NPI:1992811939
Name:PEEBLES, MARY ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:PEEBLES
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 1:899 US HIGHWAY 287 STE 600
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7319
Mailing Address - Country:US
Mailing Address - Phone:303-460-9366
Mailing Address - Fax:303-460-8056
Practice Address - Street 1:899 US HIGHWAY 287 STE 600
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7319
Practice Address - Country:US
Practice Address - Phone:303-460-9366
Practice Address - Fax:303-460-8056
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1046271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice