Healthcare Provider Details

I. General information

NPI: 1154656270
Provider Name (Legal Business Name): SMILE EIGHT PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 W 64TH AVE
LOVELAND CO
80538
US

IV. Provider business mailing address

274 W 64 AVE
LOVELAND CO
80538
US

V. Phone/Fax

Practice location:
  • Phone: 970-667-0446
  • Fax: 970-667-4196
Mailing address:
  • Phone: 970-667-0446
  • Fax: 970-667-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8757
License Number StateCO

VIII. Authorized Official

Name: CARL ALBERT BAHR
Title or Position: OWNER
Credential: DMD
Phone: 970-667-0446