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General NPI Number Information
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NPI Number | 1144742628
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Entity Type | Organization
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Legal Business Name | 5TH AVE SMILE LLC
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2044 CLINTON ST UNIT B
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City | AURORA
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State | CO
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Zip | 80010-1003
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Country | US
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Telephone | 303-360-7462
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Fax | 303-360-7475
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Provider Business Mailing Address
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Address Line | 2044 CLINTON ST UNIT B
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City | AURORA
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State | CO
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Zip | 80010-1003
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Country | US
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Telephone | 303-360-7462
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Fax | 303-360-7475
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | MR. JUSTICE OSEI TUTU
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Credential |
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Telephone | 303-360-7462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH.002024345
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License Number State | CO
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