Healthcare Provider Details

I. General information

NPI: 1053637769
Provider Name (Legal Business Name): EMBRACE KIDS, A PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 S MONACO PKWY
DENVER CO
80222-5814
US

IV. Provider business mailing address

2250 S MONACO PKWY
DENVER CO
80222-5814
US

V. Phone/Fax

Practice location:
  • Phone: 303-476-6233
  • Fax: 720-351-4427
Mailing address:
  • Phone: 303-476-6233
  • Fax: 720-351-4427

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 TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9257
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7680
License Number StateCO

VIII. Authorized Official

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