Provider Demographics
NPI:1639169246
Name:PIKE, WILLIAM R
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:PIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S SAINT VRAIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-5422
Mailing Address - Country:US
Mailing Address - Phone:970-586-9434
Mailing Address - Fax:
Practice Address - Street 1:600 S SAINT VRAIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-5422
Practice Address - Country:US
Practice Address - Phone:970-586-9434
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1044381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02044386Medicaid
CO51135OtherBCBS