Organization
SOUTH SPRINGS DENTAL PROFESSIONAL LLC
Active
Other names
South Springs Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS PEAK (OWNER/DENTIST)
(719) 494-0718
Entity
Organization
Contact information
Practice address
6514 S ACADEMY BLVD, COLORADO SPRINGS, CO 80906-8614
(719) 494-0718
Mailing address
6514 S ACADEMY BLVD, COLORADO SPRINGS, CO 80906-8614
(719) 494-0718
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
10397
CO
1223G0001X
General Practice Dentistry
Primary
10397
CO
1223P0300X
Periodontics
10397
CO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
10397
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
10397
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10397
DENTAL
CO
Enumeration date
11/29/2013
Last updated
11/29/2013
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