Provider Demographics
NPI:1194357533
Name:PEAK FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:PEAK FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VICENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-487-4008
Mailing Address - Street 1:261 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1431
Mailing Address - Country:US
Mailing Address - Phone:201-487-4008
Mailing Address - Fax:
Practice Address - Street 1:261 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1431
Practice Address - Country:US
Practice Address - Phone:201-487-4008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental