Provider Demographics
NPI:1174543391
Name:PELTON, WILLIAM THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:PELTON
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 1:1503 MADDEN CT
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-5632
Mailing Address - Country:US
Mailing Address - Phone:530-671-2921
Mailing Address - Fax:530-671-7871
Practice Address - Street 1:1503 MADDEN CT
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-5632
Practice Address - Country:US
Practice Address - Phone:530-671-2921
Practice Address - Fax:530-671-7871
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist