Individual
DOUGLAS LEE PECKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
718 CHIEF ST, BENKELMAN, NE 69021
(308) 423-2024
Mailing address
PO BOX 664, BENKELMAN, NE 69021
(308) 423-2024
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5963
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47079964513
—
NE
Enumeration date
09/11/2006
Last updated
07/08/2007
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