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General NPI Number Information
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NPI Number | 1760735856
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Entity Type | Organization
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Legal Business Name | WOODMEN DENTAL, PROFESSIONAL LLC
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Dates
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Enumeration Date | 10/26/2012
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 7685 MCLAUGHLIN RD UNIT 100
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City | FALCON
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State | CO
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Zip | 80831-4751
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Country | US
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Telephone | 719-694-1929
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Fax |
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Provider Business Mailing Address
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Address Line | 7685 MCLAUGHLIN RD UNIT 100
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City | FALCON
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State | CO
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Zip | 80831-4751
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Country | US
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Telephone | 719-694-1929
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DOUGLAS PEAK
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Credential |
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Telephone | 719-694-1929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8702
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License Number State | CO
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