Provider Demographics
NPI:1063275865
Name:PEAK 5 FAMILY DENTISTRY
Entity type:Organization
Organization Name:PEAK 5 FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTON
Authorized Official - Middle Name:JESS
Authorized Official - Last Name:BIRTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:385-368-6745
Mailing Address - Street 1:3026 W 9435 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3237
Mailing Address - Country:US
Mailing Address - Phone:385-368-6745
Mailing Address - Fax:
Practice Address - Street 1:1680 W REUNION AVE STE 6B
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4617
Practice Address - Country:US
Practice Address - Phone:385-368-6745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty