Provider Demographics
NPI:1336492040
Name:PEEK, DEREK THOMAS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:THOMAS
Last Name:PEEK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4035
Mailing Address - Country:US
Mailing Address - Phone:319-382-8002
Mailing Address - Fax:319-382-8111
Practice Address - Street 1:2929 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4035
Practice Address - Country:US
Practice Address - Phone:319-382-8002
Practice Address - Fax:319-382-8111
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-091611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics