Healthcare Provider Details

I. General information

NPI: 1801412564
Provider Name (Legal Business Name): PEAK PERIODONTAL & DENTAL IMPLANT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 E 98TH ST STE 200
CARMEL IN
46280-1973
US

IV. Provider business mailing address

3003 E 98TH ST STE 200
CARMEL IN
46280-1973
US

V. Phone/Fax

Practice location:
  • Phone: 317-843-1281
  • Fax: 317-574-9390
Mailing address:
  • Phone: 317-843-1281
  • Fax: 317-574-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL M BLACK
Title or Position: OWNER
Credential: DMD MSD
Phone: 317-843-1281