Healthcare Provider Details

I. General information

NPI: 1790343853
Provider Name (Legal Business Name): SMILE SMOKY HILL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22986 E SMOKY HILL RD
AURORA CO
80016-1382
US

IV. Provider business mailing address

5590 VESSEY RD
COLORADO SPRINGS CO
80908-3288
US

V. Phone/Fax

Practice location:
  • Phone: 303-690-1690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA ERICKSON
Title or Position: PRESIDENT
Credential: DDS, MSD
Phone: 719-439-9476