Healthcare Provider Details

I. General information

NPI: 1932022027
Provider Name (Legal Business Name): PEAK ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10359 FEDERAL BLVD STE 200
WESTMINSTER CO
80260-7453
US

IV. Provider business mailing address

10359 FEDERAL BLVD STE 200
WESTMINSTER CO
80260-7453
US

V. Phone/Fax

Practice location:
  • Phone: 303-466-1955
  • Fax:
Mailing address:
  • Phone: 303-466-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANIL IDICULLA
Title or Position: ORTHODONTIST
Credential:
Phone: 303-466-1955