Provider Demographics
NPI:1467942474
Name:PEAK FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:PEAK FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-293-2211
Mailing Address - Street 1:10429 MONTGOMERY PKWY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3864
Mailing Address - Country:US
Mailing Address - Phone:505-293-2211
Mailing Address - Fax:505-293-0915
Practice Address - Street 1:10429 MONTGOMERY PKWY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-293-2211
Practice Address - Fax:505-293-0915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK FAMILY DENTISTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-15
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD35101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty