Provider Demographics
NPI:1174360986
Name:CARON, PETER JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:CARON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 N LAKEVIEW AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1809
Mailing Address - Country:US
Mailing Address - Phone:763-227-8264
Mailing Address - Fax:
Practice Address - Street 1:957 S MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2544
Practice Address - Country:US
Practice Address - Phone:708-513-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190353301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice