Healthcare Provider Details

I. General information

NPI: 1972614071
Provider Name (Legal Business Name): SPIELMAN PEAK LOIS & HUMES DDS MS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7217 HAWKINS VIEW DR SUITE 200
FORT WORTH TX
76132-3927
US

IV. Provider business mailing address

7217 HAWKINS VIEW DR SUITE 200
FORT WORTH TX
76132-3927
US

V. Phone/Fax

Practice location:
  • Phone: 817-292-3605
  • Fax: 817-292-1743
Mailing address:
  • Phone: 817-292-3605
  • Fax: 817-292-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number16382
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21107
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number23154
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10551
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT B. PEAK
Title or Position: DOCTOR
Credential: DDS
Phone: 81729293605