Provider Demographics
NPI:1225148455
Name:PEAK, DOUGLAS LYLE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LYLE
Last Name:PEAK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3715 BLOOMINGTON ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3205
Mailing Address - Country:US
Mailing Address - Phone:719-599-0665
Mailing Address - Fax:719-599-0591
Practice Address - Street 1:3715 BLOOMINGTON ST
Practice Address - Street 2:SUITE 160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3205
Practice Address - Country:US
Practice Address - Phone:719-599-0665
Practice Address - Fax:719-599-0591
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO807021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice