Healthcare Provider Details

I. General information

NPI: 1194357533
Provider Name (Legal Business Name): PEAK FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 SUMMIT AVE
HACKENSACK NJ
07601-1431
US

IV. Provider business mailing address

261 SUMMIT AVE
HACKENSACK NJ
07601-1431
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-4008
  • Fax:
Mailing address:
  • Phone: 201-487-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LANCE A VICENTE
Title or Position: OWNER
Credential: DMD
Phone: 201-487-4008