MEDICARE: SPIELMAN PEAK LOIS & HUMES DDS MS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	16382	TX
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	21107	TX
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	23154	TX
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10551	TX

General Provider Information

NPI Number	:	1972614071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIELMAN PEAK LOIS & HUMES DDS MS INC.

Provider Business Mailing Address
First Line	:	7217 HAWKINS VIEW DR
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3927
Country	:	US
Telephone Number	:	817-292-3605
Fax Number	:	817-292-1743

Provider Business Practice Location Address
First Line	:	7217 HAWKINS VIEW DR
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3927
Country	:	US
Telephone Number	:	817-292-3605
Fax Number	:	817-292-1743

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ROBERT B. PEAK
Credential	:	DDS
Telephone Number	:	81729293605

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/25/2012

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