Provider Demographics
NPI:1306031463
Name:PEAK ENDODONTICS, P.C.
Entity Type:Organization
Organization Name:PEAK ENDODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:EVELAND
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-487-9075
Mailing Address - Street 1:2435 RESEARCH PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1070
Mailing Address - Country:US
Mailing Address - Phone:719-487-9075
Mailing Address - Fax:719-434-4865
Practice Address - Street 1:2435 RESEARCH PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1070
Practice Address - Country:US
Practice Address - Phone:719-487-9075
Practice Address - Fax:719-434-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8462261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental