Healthcare Provider Details

I. General information

NPI: 1275359655
Provider Name (Legal Business Name): SIMPLY SMILE P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E 1ST AVE. SUITE #114 UNIT 23
DENVER CO
80206-5615
US

IV. Provider business mailing address

3920 POINTER RD
LOGANVILLE GA
30052-2889
US

V. Phone/Fax

Practice location:
  • Phone: 720-854-4765
  • Fax:
Mailing address:
  • Phone: 720-854-4765
  • 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: MRS. ROCKY MOUA COATES
Title or Position: DENTAL HYGIENIST
Credential: RDH
Phone: 720-854-4765