Provider Demographics
NPI:1235353301
Name:PEAK, ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:PEAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 JEROME ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3945
Mailing Address - Country:US
Mailing Address - Phone:817-522-1833
Mailing Address - Fax:
Practice Address - Street 1:900 JEROME ST
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3945
Practice Address - Country:US
Practice Address - Phone:817-522-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85D054OtherBCBS OF TX
TXU52340Medicare UPIN