Healthcare Provider Details

I. General information

NPI: 1740691344
Provider Name (Legal Business Name): PEARLY WHITE SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 ZUNI ST STE 205
DENVER CO
80221-4689
US

IV. Provider business mailing address

8380 ZUNI ST STE 205
DENVER CO
80221-4689
US

V. Phone/Fax

Practice location:
  • Phone: 720-379-5465
  • Fax:
Mailing address:
  • Phone: 720-379-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000906497
License Number StateCO

VIII. Authorized Official

Name: MRS. CRISELDA SANCHEZ
Title or Position: DENTAL HYGIENIST
Credential: RDH
Phone: 720-379-5465