Healthcare Provider Details

I. General information

NPI: 1033034772
Provider Name (Legal Business Name): ELEVATE SMILES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 IRAN ST
DENVER CO
80249-7307
US

IV. Provider business mailing address

4425 IRAN ST
DENVER CO
80249-7307
US

V. Phone/Fax

Practice location:
  • Phone: 303-902-7820
  • Fax:
Mailing address:
  • Phone: 303-902-7820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: PRECIOUS LUSTER
Title or Position: DENTAL HYGIENIST
Credential: RDH
Phone: 303-902-7820