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Individual
PETER DANIEL CARLESIMO
Active
Individual
PETER DANIEL CARLESIMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9514
OR
1223G0001X
General Practice Dentistry
DE61007889
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D9514
DENTIST LICENSE
OR
Enumeration date
08/22/2005
Last updated
10/06/2022
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