South Beach Dental Clinic

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE008350 Issued in WA

Legal business name

SOUTH BEACH DENTAL CLINIC

Practice address

509 S Montesano St
Westport, WA 98595

Phone

(360) 268-6225

Fax

(360) 268-6095

NPI assigned

Mar 16, 2017

Last updated

Mar 16, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Duane W Pegg, DMDNPI 1003838269

Title

President

Phone

(360) 268-6225

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Duane W. Pegg, DMD

  • General Practice Dentistry
  • Westport, WA
  • NPI 1003838269
  Authorized official Same address or phone

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

{
    "created_epoch": "1489622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1437690955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2049",
            "city": "WESTPORT",
            "state": "WA",
            "postal_code": "985952049",
            "telephone_number": "360-268-6225",
            "fax_number": "360-268-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 S MONTESANO ST",
            "city": "WESTPORT",
            "state": "WA",
            "postal_code": "98595",
            "telephone_number": "360-268-6225",
            "fax_number": "360-268-6095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BEACH DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-16",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "PEGG",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-268-6225",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE008350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chantel Louise Nelson, LMP, ACSM
• Ocosta School District
• Duane W. Pegg, DMD
• Doris Elaine Reed, M.S., L.AC.
• Jessica Sison
• South Beach Regional Fire Authority
• South Beach Regional Fire Authority
• Aquila Stoneking, MS
• Twin Harbor Drug, Inc. (Twin Harbor Drug)
• Angie Vogelsang, LMP, CST

• General Practice Dentistry in Westport, WA
• Providers in Westport, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; 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.