Provider Demographics
NPI:1467803205
Name:PEAK ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:PEAK ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-204-6707
Mailing Address - Street 1:496 N 990 W STE G
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2782
Mailing Address - Country:US
Mailing Address - Phone:801-477-7325
Mailing Address - Fax:801-492-7900
Practice Address - Street 1:496 N 990 W STE G
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2782
Practice Address - Country:US
Practice Address - Phone:801-477-7325
Practice Address - Fax:801-492-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9637455-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty