Active NPI
Douglas Lyle Peak Jr., DDS
- General Practice Dentistry
- Colorado Springs, CO
National Provider Identifier
1225148455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 80702
- Practice address
- 3715 Bloomington St
Suite 160
Colorado Springs, CO 80922-3205 - Phone
- (719) 599-0665
- Fax
- (719) 599-0591
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 80702 | CO | Primary |
Addresses
Primary practice location
3715 Bloomington St
Suite 160
Colorado Springs, CO 80922-3205
Mailing address
3715 Bloomington St
Suite 160
Colorado Springs, CO 80922-3205
Phone (719) 599-0665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80702 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286409600000",
"number": "1225148455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3715 BLOOMINGTON ST",
"address_2": "SUITE 160",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809223205",
"telephone_number": "719-599-0665",
"fax_number": "719-599-0591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3715 BLOOMINGTON ST",
"address_2": "SUITE 160",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809223205",
"telephone_number": "719-599-0665",
"fax_number": "719-599-0591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEAK",
"first_name": "DOUGLAS",
"middle_name": "LYLE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2010-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "80702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
- Peak Vista Community Health Centers (Peak Vista Pharmacy at Academy)
- Peak Vista Community Health Centers (The Place)
- Peak Vista Community Health Centers (Heath Center at Academy Suite 3500)
- Peak Vista Community Health Centers (Downtown Health Center)
- Peak Wellness Counseling Service, LLC
- Nicole Peak, PH.D.
- Jessica Lynn Peake, OTR/L
- Peakmed Colorado, LLC
- Peakmed Colorado, LLC
- Peakmed Colorado, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.