Provider Demographics
NPI:1972908309
Name:ROBERT B, PEAK, DDS, PLLC
Entity Type:Organization
Organization Name:ROBERT B, PEAK, DDS, PLLC
Other - Org Name:MIDTOWN ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-205-2340
Mailing Address - Street 1:900 JEROME ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3945
Mailing Address - Country:US
Mailing Address - Phone:817-205-2340
Mailing Address - Fax:
Practice Address - Street 1:900 JEROME ST
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3945
Practice Address - Country:US
Practice Address - Phone:817-205-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16382261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery