| NPI | 1659702769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS PEAK Owner/Dentist 719-494-0718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 10397) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CO 10397) |
| 1223P0300X Dentist Periodontics (Licence: CO 10397) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO 10397) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CO 10397) | |
| Enumeration Date | 2013-11-29 |
| Last Update Date | 2013-11-29 |