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General NPI Number Information
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NPI Number | 1083848857
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Entity Type | Organization
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Legal Business Name | SMILE FOUR PROFESSIONALS LLC
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 1221 S PUEBLO BLVD
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City | PUEBLO
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State | CO
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Zip | 81005-1507
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Country | US
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Telephone | 719-565-2274
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Fax | 719-565-6829
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Provider Business Mailing Address
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Address Line | 1221 S PUEBLO BLVD
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City | PUEBLO
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State | CO
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Zip | 81005-1507
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Country | US
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Telephone | 719-565-2274
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Fax | 719-565-6829
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Authorized Official
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Title or Position | OWNER
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Name | DR. TANIA QUINN
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Credential | DMD
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Telephone | 719-565-2274
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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 |
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License Number State |
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