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General NPI Number Information
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NPI Number | 1205794468
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Entity Type | Organization
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Legal Business Name | SMILE VISTA KIDS DENTISTRY & ORTHODONTICS LLC
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 4499 W 38TH AVE UNIT 101
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City | DENVER
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State | CO
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Zip | 80212-2199
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Country | US
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Telephone | 303-827-0606
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Fax | 303-827-0606
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Provider Business Mailing Address
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Address Line | 4499 W 38TH AVE UNIT 101
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City | DENVER
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State | CO
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Zip | 80212-2199
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Country | US
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Telephone | 303-827-0606
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Fax | 303-827-0606
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Authorized Official
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Title or Position | DIRECTOR OF PAYOR RELATIONS
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Name | CASSANDRA WIETH
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Credential |
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Telephone | 623-267-8121
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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