| NPI | 1972614071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT B. PEAK Doctor 8172-929-3605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 10551) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 16382) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 21107) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23154) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-05-25 |