Gadia Kumunjun Peabody, DDS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

2901011507 Issued in MI

Practice address

2201 S Getty St
Muskegon, MI 49444-1207

Phone

(231) 767-9830

Fax

(231) 737-1808

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480982400000",
    "number": "1457570863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 S GETTY ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441207",
            "telephone_number": "231-767-9830",
            "fax_number": "231-737-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 S GETTY ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441207",
            "telephone_number": "231-767-9830",
            "fax_number": "231-737-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEABODY",
        "first_name": "GADIA",
        "middle_name": "KUMUNJUN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2016-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "63907",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026130",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MI",
            "license": "2901011507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Allen Pavey
• Susan D Pavlik, LLP LIMITED LICENSE
• Patrick Pavwoski, D.O.
• Catherine S Payment, RN
• Shawndreka Shanay Payne, MA, LLPC
• Elizabeth Marie Pearson, PHARMD
• Marcella Merrin Peebles, DMD
• Gera Peel
• Thomas C Peeples, MD
• Benjamin Joel Pell Sr., CRNA

• Prosthodontics in Muskegon, MI
• Providers in Muskegon, MI by specialty
• Prosthodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2016; 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.