Individual
DR. KENNETH ALTON PEAVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1400 WESTGATE CENTER DR, SUITE 204, WINSTON SALEM, NC 27103-3104
(336) 774-3001
(336) 774-9161
Mailing address
1400 WESTGATE CENTER DR, SUITE 204, WINSTON SALEM, NC 27103-3104
(336) 774-3001
(336) 774-9161
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
5876
NC
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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