Wayne Winfred Peavy, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8990 Issued in TX

Practice address

2902 Denton Highway
Haltom City, TX 76117

Phone

(817) 838-7611

Fax

(817) 838-8941

NPI assigned

Apr 26, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417564800000",
    "number": "1396965133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 DENTON HIGHWAY",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "76117",
            "telephone_number": "817-838-7611",
            "fax_number": "817-838-8941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2902 DENTON HIGHWAY",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "76117",
            "telephone_number": "817-838-7611",
            "fax_number": "817-838-8941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEAVY",
        "first_name": "WAYNE",
        "middle_name": "WINFRED",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2014-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "8990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Pace
• Kee Joo Paik, PHARM.D
• Chung Whiy Park
• Samuel Adolphus Partida III, LCDC
• Fatima Shaaran Patterson, LMT
• Tamara Peck
• Chuong Van Pham, D.C.
• Donna Duyen Pham
• Tiana Hoang Thy Pham, D.D.S.
• Kristen R. Potts, RDH

• General Practice Dentistry in Haltom City, TX
• Providers in Haltom City, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.