Provider Demographics
NPI:1679786487
Name:PEIK, FERDINAND WESLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:WESLEY
Last Name:PEIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 HAWTHORN PL
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8099
Mailing Address - Country:US
Mailing Address - Phone:317-773-8794
Mailing Address - Fax:
Practice Address - Street 1:3421 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3852
Practice Address - Country:US
Practice Address - Phone:765-453-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN64181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6418Medicare UPIN
IN362230Medicare ID - Type Unspecified