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General NPI Number Information
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NPI Number | 1467803205
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Entity Type | Organization
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Legal Business Name | PEAK ORTHODONTICS PLLC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 496 N 990 W STE G
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2782
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Country | US
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Telephone | 801-477-7325
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Fax | 801-492-7900
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Provider Business Mailing Address
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Address Line | 496 N 990 W STE G
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2782
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Country | US
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Telephone | 801-477-7325
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Fax | 801-492-7900
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Authorized Official
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Title or Position | MANAGING ORTHODONTIST
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Name | DR. THARON SMITH
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Credential | D.D.S
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Telephone | 520-204-6707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9637455-9921
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License Number State | UT
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