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General NPI Number Information
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NPI Number | 1003132366
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Entity Type | Organization
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Legal Business Name | EMBRACE KIDS, A PROFESSIONAL LLC
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 15159 E COLFAX AVE UNIT B
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City | AURORA
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State | CO
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Zip | 80011-5705
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Country | US
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Telephone | 303-341-5437
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Fax | 303-341-5447
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Provider Business Mailing Address
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Address Line | 2020 WADSWORTH BLVD SUITE 18-A
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City | LAKEWOOD
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State | CO
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Zip | 80214-5728
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Country | US
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Telephone | 303-462-1462
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Fax | 303-997-5646
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | YVETTE MADRIGAL
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Credential |
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Telephone | 303-462-1462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6889
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9224
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9257
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License Number State | CO
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