Healthcare Provider Details

I. General information

NPI: 1164607768
Provider Name (Legal Business Name): SMILE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 E 3RD AVE
DENVER CO
80206-4705
US

IV. Provider business mailing address

2617 E 3RD AVE
DENVER CO
80206-4705
US

V. Phone/Fax

Practice location:
  • Phone: 303-225-0525
  • Fax: 303-225-0526
Mailing address:
  • Phone: 303-225-0525
  • Fax: 303-225-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8281
License Number StateCO

VIII. Authorized Official

Name: DR. DAMON C WILKERSON
Title or Position: OWNER
Credential: DDS
Phone: 303-225-0525