Healthcare Provider Details

I. General information

NPI: 1750246971
Provider Name (Legal Business Name): PEAK DENTAL IMPLANTS & ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BLOOMFIELD AVE STE 405
WINDSOR CT
06095-2700
US

IV. Provider business mailing address

360 BLOOMFIELD AVE STE 405
WINDSOR CT
06095-2700
US

V. Phone/Fax

Practice location:
  • Phone: 402-805-4516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HERITAGE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 402-805-4516