Healthcare Provider Details

I. General information

NPI: 1003132366
Provider Name (Legal Business Name): EMBRACE KIDS, A PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15159 E COLFAX AVE UNIT B
AURORA CO
80011-5705
US

IV. Provider business mailing address

2020 WADSWORTH BLVD SUITE 18-A
LAKEWOOD CO
80214-5728
US

V. Phone/Fax

Practice location:
  • Phone: 303-341-5437
  • Fax: 303-341-5447
Mailing address:
  • Phone: 303-462-1462
  • Fax: 303-997-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6889
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9224
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9257
License Number StateCO

VIII. Authorized Official

Name: YVETTE MADRIGAL
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-462-1462