Provider Demographics
NPI:1619289238
Name:PECK, CHRISTIAN SARGENT (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:SARGENT
Last Name:PECK
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 1:521 N 11TH ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5045
Mailing Address - Country:US
Mailing Address - Phone:804-827-1244
Mailing Address - Fax:804-827-1244
Practice Address - Street 1:2624 GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4676
Practice Address - Country:US
Practice Address - Phone:970-928-9500
Practice Address - Fax:804-827-1244
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412894122300000X
NMD37451223P0221X
CO002053201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist