Michael A. Peck, D.D.S., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

13995 Issued in TX

Practice address

5038 Tennyson Pkwy
Suite a
Plano, TX 75024-2954

Phone

(972) 403-8700

Fax

(972) 403-8788

NPI assigned

May 4, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258588800000",
    "number": "1255543146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5038 TENNYSON PKWY",
            "address_2": "SUITE A",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750242954",
            "telephone_number": "972-403-8700",
            "fax_number": "972-403-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5038 TENNYSON PKWY",
            "address_2": "SUITE A",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750242954",
            "telephone_number": "972-403-8700",
            "fax_number": "972-403-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "MICHAEL",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2009-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "13995",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "13995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carmelita M Pearson, M.D.
• Karen Brazell Pearson, MSN, CRNP
• Noel Truong Pearson, NP
• Aimee Larsen Pease
• Iva Lim Peck, LAC.,DIPL.AC.,RN
• Nichole Peck
• Richard Austin Peck, L. AC.
• Pediatric After Hours Management, L.L.C.
• Pediatric and Adolescent Medical Center
• Pediatric Associates of North Texas

• Periodontics in Plano, TX
• Providers in Plano, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.