Provider Demographics
NPI:1881946309
Name:PEAK ORAL & MAXILLOFACIAL SURGERY CENTER
Entity type:Organization
Organization Name:PEAK ORAL & MAXILLOFACIAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAEMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-232-5637
Mailing Address - Street 1:2290 KIPLING ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1578
Mailing Address - Country:US
Mailing Address - Phone:303-232-5637
Mailing Address - Fax:
Practice Address - Street 1:2290 KIPLING ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1578
Practice Address - Country:US
Practice Address - Phone:303-232-5637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty