# SOUTH BEACH DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437690955
- **Authorized official:** DUANE W PEGG DMD (PRESIDENT)
- **Authorized official phone:** (360) 268-6225

## Contact information

- **Practice address:** 509 S MONTESANO ST, WESTPORT, WA 98595
- **Practice address phone:** (360) 268-6225
- **Practice address fax:** (360) 268-6095
- **Mailing address:** PO BOX 2049, WESTPORT, WA 98595-2049
- **Mailing address phone:** (360) 268-6225
- **Mailing address fax:** (360) 268-6095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE008350 | WA | Yes |

## Other

- **Enumeration date:** 03/16/2017
- **Last updated:** 03/16/2017