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General NPI Number Information
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NPI Number | 1881946309
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Entity Type | Organization
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Legal Business Name | PEAK ORAL & MAXILLOFACIAL SURGERY CENTER
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 2290 KIPLING ST SUITE 2
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City | LAKEWOOD
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State | CO
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Zip | 80215-1578
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Country | US
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Telephone | 303-232-5637
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Fax |
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Provider Business Mailing Address
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Address Line | 2290 KIPLING ST SUITE 2
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City | LAKEWOOD
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State | CO
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Zip | 80215-1578
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Country | US
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Telephone | 303-232-5637
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HAEMAN NOORI
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Credential | DDS
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Telephone | 303-232-5637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10330
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License Number State | CO
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