MEDICARE: TICKET TO SMILES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	9177	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376702787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TICKET TO SMILES PC

Provider Business Mailing Address
First Line	:	12373 E CORNELL AVE # 16
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-3323
Country	:	US
Telephone Number	:	303-750-7750
Fax Number	:	303-750-1374

Provider Business Practice Location Address
First Line	:	12373 E CORNELL AVE # 16
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-3323
Country	:	US
Telephone Number	:	303-750-7750
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANDREW T NGUYEN
Credential	:	DDS
Telephone Number	:	303-750-7750

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	08/31/2011

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Directions to “TICKET TO SMILES PC ” Practice Location

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