1649349812 NPI number — PEAK DENTISTRY LLC

Table of content: (NPI 1649349812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649349812 NPI number — PEAK DENTISTRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK DENTISTRY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TODD ROBISON DMD MANDY ROBISON DDS MANDY NEWCOMER DDS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649349812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2690
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDWARDS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-926-7325
Provider Business Mailing Address Fax Number:
970-926-7327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34323 US HWY 6
Provider Second Line Business Practice Location Address:
#C107
Provider Business Practice Location Address City Name:
EDWARDS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-926-7325
Provider Business Practice Location Address Fax Number:
970-926-7327
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBISON
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
DENTIST OWNER
Authorized Official Telephone Number:
970-926-7325

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DEN8978 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: DEN8957 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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