MEDICARE: CHILDREN'S SMILE CENTER

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	6134	CO

General Provider Information

NPI Number	:	1831424738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S SMILE CENTER

Provider Business Mailing Address
First Line	:	7770 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4087
Country	:	US
Telephone Number	:	719-598-0012
Fax Number	:

Provider Business Practice Location Address
First Line	:	7770 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4087
Country	:	US
Telephone Number	:	719-598-0012
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. THEODORE M GEORGE
Credential	:	D.D.S.
Telephone Number	:	719-598-0012

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

Similar Medicare Providers

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Practice Location Address:

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1437126471 — DR. THEODORE M. GEORGE DDS
Practice Location Address:

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1326417197 — SPRINGS SMILE CENTER
Practice Location Address:

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1982074142 — SERENE DENTAL HYGIENE
Practice Location Address:

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1811940067 — DR. KATHARINE JULIA LEPPARD M.D.
Practice Location Address:

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Directions to “CHILDREN'S SMILE CENTER ” Practice Location

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