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General NPI Number Information
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NPI Number | 1619289238
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Entity Type | Individual
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Provider Name | CHRISTIAN SARGENT PECK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 2624 GRAND AVE STE 200
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4676
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Country | US
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Telephone | 970-928-9500
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Fax | 804-827-1244
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Provider Business Mailing Address
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Address Line | 521 N 11TH ST SUITE 315
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City | RICHMOND
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State | VA
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Zip | 23298-5045
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Country | US
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Telephone | 804-827-1244
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Fax | 804-827-1244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412894
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D3745
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 00205320
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License Number State | CO
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