# PAGOSA PEAK FAMILY DENTISTRY, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184377392
- **Authorized official:** DR. PETER ROUKEMA DMD (PRESIDENT)
- **Authorized official phone:** (216) 374-5693

## Contact information

- **Practice address:** 228 VILLAGE DR, PAGOSA SPRINGS, CO 81147-8308
- **Practice address phone:** (216) 374-5693
- **Mailing address:** 115 HAREBELL DR, PAGOSA SPRINGS, CO 81147-7721
- **Mailing address phone:** (216) 374-5693

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/28/2022
- **Last updated:** 01/28/2022