South Springs Dental Professional LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10397 Issued in CO

Legal business name

SOUTH SPRINGS DENTAL PROFESSIONAL LLC

Practice address

6514 S Academy Blvd
Colorado Springs, CO 80906-8614

Phone

(719) 494-0718

NPI assigned

Nov 29, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Douglas Peak

Title

Owner/Dentist

Phone

(719) 494-0718

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• South Springs Dental Group Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385683200000",
    "number": "1659702769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6514 S ACADEMY BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809068614",
            "telephone_number": "719-494-0718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6514 S ACADEMY BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809068614",
            "telephone_number": "719-494-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SPRINGS DENTAL PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-29",
        "last_updated": "2013-11-29",
        "status": "A",
        "authorized_official_last_name": "PEAK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "719-494-0718",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CO",
            "license": "10397",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "10397",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "10397",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "10397",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CO",
            "license": "10397",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL",
            "identifier": "10397",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Springs Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Soullabor LLC
• Claudevania Sousa Dantas
• Teresa Sousa
• South Powers Dental Prof LLC
• South Spring Lab, LLC
• James Willis South, PA-C
• Leanne South, PT, DPT
• Samuel D. South, MD
• Hannah Southerland, PHARMD
• Southern Colorado Anesthesia Associates PC

• General Practice Dentistry in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.