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General NPI Number Information
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NPI Number | 1205375946
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Entity Type | Organization
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Legal Business Name | MOBILE SMILES LLC
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 2510 ANTIETAM LN
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-1403
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Country | US
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Telephone | 719-351-0524
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 ANTIETAM LN
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-1403
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Country | US
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Telephone | 719-351-0524
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. MARIA DOLORES MILNER
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Credential | RDH
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Telephone | 719-351-0524
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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 | 2638
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License Number State | CO
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