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General NPI Number Information
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NPI Number | 1386134773
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Entity Type | Organization
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Legal Business Name | PEAK DENTAL P.C.
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 124 NORTHERN LIGHTS DR
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-4113
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Country | US
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Telephone | 315-299-5777
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Fax | 315-802-2786
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Provider Business Mailing Address
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Address Line | 124 NORTHERN LIGHTS DR
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-4113
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Country | US
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Telephone | 315-299-5777
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Fax | 315-802-2786
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Authorized Official
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Title or Position | SUPERVISIOR
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Name | MELISSA MARIE LAFFERTY
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Credential |
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Telephone | 315-283-0857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 051614
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License Number State | NY
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