Provider Demographics
NPI:1649380882
Name:DOUGAS PEAK DDS, PC
Entity Type:Organization
Organization Name:DOUGAS PEAK DDS, PC
Other - Org Name:ALL SMILES DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:PEAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-599-0665
Mailing Address - Street 1:3715 BLOOMINGTON ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3205
Mailing Address - Country:US
Mailing Address - Phone:719-599-0665
Mailing Address - Fax:
Practice Address - Street 1:3715 BLOOMINGTON ST
Practice Address - Street 2:SUITE 160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3204
Practice Address - Country:US
Practice Address - Phone:719-599-0665
Practice Address - Fax:719-599-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty