Derrick H Peck, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11637 Issued in MT

Practice address

5215 N Bend Rd
Cincinnati, OH 45247-8006

Phone

(513) 481-8051

NPI assigned

Jul 9, 2015

Sex

Male

Sole proprietor

No

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 MT

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

State licenses

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

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509062400000",
    "number": "1700260650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 N BEND RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452478006",
            "telephone_number": "513-481-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 N BEND RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452478006",
            "telephone_number": "513-481-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "DERRICK",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-09",
        "last_updated": "2017-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "11637",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.024471",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julianne Pece, LSW
• Allan Peck, M.D.
• Amanda Peck, PHARMD
• Amanda Elise Peck, MD
• Brittany Nicole Peck, PC
• Fred H Peck, D.D.S.
• Hannah Renee Peck
• Lauren A Peck, M.D.
• Madison Peck, PT, DPT
• Rachael Peck

• General Practice Dentistry in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2017; 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.