=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124818323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAQUE TO THE FUTURE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 W LITTLETON BLVD UNIT A
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-2138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-719-0012
-----------------------------------------------------
Fax | 720-719-0026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 W LITTLETON BLVD UNIT A
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-2138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-719-0012
-----------------------------------------------------
Fax | 720-719-0026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | HECTOR MIRAMONTES
-----------------------------------------------------
Credential | OM
-----------------------------------------------------
Telephone | 303-333-5148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------