Provider Demographics
NPI:1548339997
Name:PEERS, WADE A (DDS)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:A
Last Name:PEERS
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 1:2750 RASMUSSEN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5401
Mailing Address - Country:US
Mailing Address - Phone:435-615-9840
Mailing Address - Fax:435-615-9842
Practice Address - Street 1:2750 RASMUSSEN RD STE 106
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5401
Practice Address - Country:US
Practice Address - Phone:435-615-9840
Practice Address - Fax:435-615-9842
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT983629871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery