Provider Demographics
NPI:1982053351
Name:HAMPDEN DENTAL PROFESSIONAL
Entity Type:Organization
Organization Name:HAMPDEN DENTAL PROFESSIONAL
Other - Org Name:HAMPDEN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-599-0665
Mailing Address - Street 1:18121 E HAMPDEN AVE
Mailing Address - Street 2:UNIT E
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3590
Mailing Address - Country:US
Mailing Address - Phone:303-317-5335
Mailing Address - Fax:
Practice Address - Street 1:18121 E HAMPDEN AVE
Practice Address - Street 2:UNIT E
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-3590
Practice Address - Country:US
Practice Address - Phone:303-317-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty